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M What is the depth to groundwater? ( s r <br /> Describe the source of Information: <br /> ice'r d t+ rtvti Q w <br /> 13. Are there any water wells on this parcel or adjacent propertles? YES (j No <br /> TYR OF WULS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well fL <br /> IrrigLtIon Well tt. <br /> Monitoring Well ft. <br /> Other R <br /> 14 Will the s)pending clean be replaced with an abovqmund or underground storage 8)4 YMO NO[ <br /> i5. Indicate the responsible party to be billed for additional Pnmm stAff thele nded beyond 8 hour miniumm permit payment <br /> per tank If the party designated below Is different than the permit Appilimut.e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature d date below. <br /> Name F ® le :Ui nt h. <br /> Maftg Address c. <br /> Day Phone Number(� 1 <br /> Title ate <br /> EH 23 046(Rev' 10/19/98) Page 6 <br />