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12. What is the depth to groundwater? t1 /--N o W fi <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ ] <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 />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ 1 <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br />per tank. If the party designated below is different than the permit applicant, e.g. property owner, the party must acknowledge <br />this responsibility for the billing by signature and date below. <br />Name L G SE a -V ►'c6S <br />Mailing Address PAA kv+'£w - F"12SND , <br />Day Phone Number( 4 y q - <br />3 - 2-4o - <br />Signature Title Date <br />EH 23 046 (Revised 08/13/99) Page 6 <br />