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X- <br />12. What is the depth to groundwater? a CJ / �dt [ l g� Z''�'�-� <br />Describe the source of information: <br />San ToaCp. �hV1P C t� <br />13. Are there any water wells on this parcel or adjacent properties? YES K NO [ <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />( Q ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES)< NO[ <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 ,S A M b 2 1017 db <br />0 6V r2 <br />Title <br />EH 23 046 (Revised 7/10/96) Page 6 <br />