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12. What is the depth to groundwater? Y+fA <br />Describe the source of inforwatiop: P- V <br />13. Are there any water wells on this parcel or adjacent properties? YES I I NO IX <br />TYPE OF WELLS <br />I DISTANCE TO TANKS(S) <br />Public Well <br />Private Well <br />Irrigation Well <br />Monitoring Well <br />ft. <br />Other <br />14. Will the tank(s) pending closure be replaced with an aboveground orjLadjEopmajLstorage tank(s)? YESLX NO[ I <br />15. 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 <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name <br />Day Phone Number( A Qq ) 943 - A03- q77 ® 3&q,3 <br />X xz�z <br />Signature Title Date <br />EH 23 046 (Revised 9/11/96) Page 6 <br />