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12. What Is the depth to groundwater? <br />Describe the source of Information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [I NO [ 1 <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />it. <br />Private Well <br />( it. <br />I <br />Irrigation Well <br />tC <br />Monitoring Well <br />ft. <br />Other <br />iL <br />14. Will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? YESI j NO[ 1 <br />15. indicate the responsible party to be billed for additional PHS-EHD staff time Mended 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 />Hailing Address <br />Day Phone Number <br />Signature Title Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />