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12. What is the depth to groundwater? <br />Describe the source of information: <br />& UJ ytwq,�(Owl� 4 -4� 11#� T <br />13. Are there any water wells on this parcel or adjacent properties? <br />14. <br />15. <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />YESX NO [ ] <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage <br />tank(s)? YES[ ) NOp( <br />Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different than the permit applicant, e.g. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name B it d <br />Mailing Address Z J M '1 ��y''CF• Cj 1(G Z�G ` j Z <br />Day Phone Number <br />Signature Ti e <br />EH 23 046 (Revised 10/16/03) Page 6 <br />O9 Lo ay <br />T <br />ate <br />