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I <br /> 12. What is the depth to groundwater? <br /> Describe the source of Information: <br /> Q. Are there any water wells on this parcel or adjacent properties? YES [I NOV <br /> 4t _ <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well tt. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> S <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[ ([ <br /> Voik&= 4W <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 <br /> Mailing Address <br /> Day Phone Number(— <br /> 2 <br /> Si 4atur -- <br /> Title Date <br /> I <br /> I � <br /> L; EH 23 046 (Revised 08/13/99) Page 6 <br />