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wj <br />�d <br />�w <br />12. What is the depth to groundwater? <br />13. <br />14. <br />15. <br />Describe the source of Information.- <br />Are <br />nformation: <br />Are there any water wells on this parcel or adjacent properties? <br />Mfg •���[r ' '.'la��'i��:Cy�it�il�►�k1:�' <br />Irrigl��A <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ ] <br />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, e.g. property owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name <br />Mailing „ ! %' ♦ 1Day Phone Number LZ <br />Signature <br />Page 6 <br />Dat <br />