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12. What is the depth to groundwater? Unknown by Contractor. --- <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 DISTANCE TO TANKS(S) <br /> Public Well • <br /> Private Well — <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]NO[]X <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 The Record, Stockton Newspapers , Inc. <br /> Mailing Address P.O. Box 900 , Stockton, CA 95201 <br /> Day Phone Number 209 94 -8550 <br /> Signature Title Date <br /> EH 1-3 046 (Revised 08/13/99) Pa,2e 6 <br />