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i <br /> r) <br /> 12. What Is the depth to groundwater? 7-/0 feet <br /> Describe the source of information: /� <br /> e t e c As—s <br /> r i r. i 1 <br /> t3. Are there any water wells on this parcel or adjacent properties) YES [ ] NOOJN- <br /> TYPE, OF WELLS DISTANCE. TO TANK.�(S) <br /> Public Well ft- <br /> k Private Well ft- <br /> irrigation Well ft- <br /> Monitoring Well ft. <br /> Other ft. <br /> r <br /> Ill. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ J N <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br /> permit pnyment 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 /> F , Name <br /> _ I <br /> r- Mailing Address <br /> i <br /> Day Phone Number <br /> S' ature Title Date <br /> F <br /> F <br /> F-1t 23 046 (Revised 9/11/96) Page 6 <br /> i <br />