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12. What is the depth to groundwater? `�✓ , ' — V\ N <br /> Describe the source of information: <br /> 1 Are there any water wells on this parcel or adjacent properties? uv%kyN ouo h YES [I NON] <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 /> 1.4. Will the tank(s)pending closure be replaced with an aboveground or underground storage <br /> tank(s)?YES[]NO[] rL)),4 V <br /> 1.5. 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 /> Mailing Address <br /> Day Phone Number( ) <br /> Signature Title Date <br /> FAA 23 046(Revised 10/16/03) Page 6 <br />