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12. What is the depth to groundwater? <br />Describe the source of information:X <br />� . 1 <br />13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO �Y <br />14. <br />TYPE OF WELLS <br />I DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irri ation Well <br />ft. <br />Monitorin Well <br />ft. <br />Other <br />ft <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOWI- <br />15. Indicate the responsible party to be billed for additional 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 J � 2 <br />Mailing Address /b <br />Number (-d c7' j ) ..Q-99— <br />C� fv }+ 21— <br />Title <br />EH 23 046 (Revised 07/31/09) 6 <br />��Date <br />