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12 What is the depth to groundwater9 � 1 <br /> Describe the source of information Ghe 0roA P79,74 mer/ <br /> ' 13 Are there any water wells on this parcel of adjacent properties? YES (] NO (] <br /> TYPE OF DISTANCE TO <br /> WELLS TANKS(S) <br /> SPublic Well ft <br /> Private Well ft <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 <br /> tank(s)9 YES[] NOK <br /> 15 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 <br /> 1 Mailing Address cr <br /> Day Phone Number <br /> Signature Title Date <br /> ' EH 23 046 (Revised 3115102) Page 6 <br />