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12. What Is the depth to groundwater? /0 <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [j NO <br /> TYPE OF WUM DISTANCE TO T <br /> Public Well ft <br /> Private Well n- <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> I <br /> 19. Will the tanks)pending closure be replaced with an aboveground or underground storage ta*s)?YE O[) <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 (+ w <br /> Mailing Address 1P 2�57 0,roo k-42G1 �i f.A q52�9 <br /> Day Phone Number( 2® l ) j 6-j fy 7 <br /> I <br /> I <br /> EH 23 046(Revised 08/13/99) Page 6 <br />