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12. What is the depth to grourt#water? <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES J NO I �X <br /> TYPE OF WELLS 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( I N( C <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant, eg, property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Marne <br /> Mailing Address Samo _ _ 1 <br /> Da `lumber ( ) <br /> f <br /> Signatur `Title Date <br /> c <br /> EH 23 046 (Revised 9111196) Page 6 <br />