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0 0 <br /> L2. What is the depth to groundwater? <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES I ] NO [ ] <br /> TYPE OF WELIS DISTANCE TO TANKS(S) <br /> Public 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 tank(s)? YES[ ] NO[ ] <br /> 15. Indicate the responsible party to be billed for additional PIIS-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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name --J'AU M 'M 4'prTt{ <br /> Mailing Address RCOC1437—//6 T f;- e: k- CLQ <br /> ,vig <br /> 767 <br /> e <br /> Day Phone Number ZO 7(�!'�— 9 / 6 / <br /> Signatu Date <br /> Page 6 <br />