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12-10-1998 3 : 38P 1 r*1 • <br />112. What is the depth to groundwater' <br />Describe the source of information: <br />1 <br />Va. Are there any nater wells on this parcel or adjacent properties? <br />14. <br />15. <br />TYPE OF WU I S <br />Public Wed <br />DISTANCE TO TkWS(S) <br />tt. <br />Private Well <br />Irrigation Welt <br />r -- <br />� it <br />monitoring Well <br />I VTM it. �— f <br />Other - <br />ft. <br />YES j v <br />Will the tank.(s) pending closure be replaced with an aboveground or underground storage tanks)? YES NOj j <br />P. <br />Indicate the responsible party to be bitted for additional PI(S•E® stats 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 aelmowiedge <br />this responsibiiitq for the billing by signature and date below. <br />Name <br />Mailing Address <br />Day Pbone Number'( U ) � F t — ��i q ( <br />SlgIIatme % Tltte slate <br />EH 23 046 (Rcv4ed 10119%98) Page 6 <br />