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P. 7 <br /> 12. What is the depth to groundwater? ®��' ® ���x . <br /> Describe the source of Information: - <br /> 1�9 4t <br /> 13. Are there any water wells on this parcel or adjacent properties? YES YNO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well <br /> Private Well ft. <br /> Irrigation Well n, <br /> Monitoring Weil n, <br /> Other <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[j NX <br /> 15. Indicate the responsible party to be billed for additional PHS-£HD 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 <br /> Mailing Address 2 ®�0i JJ/A►^-i�' <br /> Day Phone Number <br /> /��= <br /> afore Title — <br /> ate <br /> H 23 046 (Revised 08/13/99) Page 6 <br />