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12. What is the depth to groundwater? <br /> Describe the source of information: C/ <br /> 13. Are there any water wells on this parcel or adjacent properties? YESXNO [] <br /> TYPE OF DISTANCE TO <br /> WELLS TANKS(S) <br /> Public Well <br /> Private Well ft. <br /> ' <br /> Irrigation Well ft. <br /> Monitorin Well <br /> Other ff• <br /> 14. Will the tanks pending closure be replaced with an aboveground or underground storage <br /> tank(s)?YWV0[] <br /> ed for additional EHD staff time expended beyond 3 hour minimum <br /> 15. Indicate the responsible party to be bill <br /> j 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 0�C2 <br /> Mailing Address / <br /> Day Phone Number 2. <br /> Signature Title Date <br /> EH 23 046(Revised 3/15/02) Page 6 <br />