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I2. What is the depth to groundwater? <br /> Describe the source of information: <br /> J� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES tt NO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YESI 1 NON <br /> 15 Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br /> • permit payment per tank. If the party designated below is different than the permit applicant, e g property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name C-NL JOC, <br /> Mailing Address P �Qo.�-o _, Sy y Q (loo Vc cr=&,L r I 1p CA6 <br /> Day Phone Number y q(f :f)1'9 (p _ <br /> Signature TitleJ Date <br /> . EH 23 046 (Revised 9/11/96) Page 6 <br />