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L <br />E <br />[IN <br />n <br />LI <br />k <br />I <br />H <br />k <br />11 <br />What is the depth to groundwatee. f�— <br />Describe the source of information: <br />I C. <br />Are there any water wells on this parcel or adjacent properties? <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ NO[11.," <br />15. Indicate the responsible party to be billed for additional PHS-EYID staff time expended beyond 3 hour minimum <br />permit payment per tanL It the party designated below is different than the permit applicant, e.g. property owner, <br />the party must aclmowledge this responsibty for the bng by signature and date below. <br />Namedi <br />Mailing Address <br />Day Phone Number -2 <br />�4 <br />"LAU"lua; <br />Date 7 <br />