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12. What is the depth to groundwater? Dl�( <br />Describe the source of information: <br />W 0 (TM1QS- Wa i-tiS LVCA--m 121) ? 'PPL -6 PaMf-7 <br />13. Are there any water wells on this parcel or adjacent properties? YES [ 1 NO[ 1 <br />TYPE OF WELLS <br />14. <br />DISTANCE TO TANKS(S) <br />Public Well <br />d <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />tL <br />Monitoring Well <br />ft. <br />Other <br />ft - <br />t <br />14. Will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ 1 N0)( <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 n7T U.AtiI P RO'De"'R-7Zg5 <br />Mailing Address "?- 0 t (0 (5z - <br />Day Phone Number ( G�1 03e <br />Z-- <br />Signatar4 Tule Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />