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012. What is the depth to groundwater? i i rr p 7 C J, y is Ar -1 <br />Describe the source of information: r' 41,. i- <br />i e G f' t'C c / 6.61 c % i l /N .0 i %V" 14 L <br />13. Are there any water wells on this parcel or adjacent properties? YES N NO[] <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />;v�ctiircr2iMG-- <br />L�LJ C- ^4 SiT[- <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES14 NO[ <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 i' C e:,l 9 K r 14 y �r <br />Day Phone Number( L j ) 8 3 y a a 3 <br />AL� <br />Signature Title D A <br />WH 23 046 (Revised 08/13/99) Page 6 <br />