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12. What is the depth to groundwater? "T <br /> Describe the source of information: <br /> (e6 tz( r- Gc G-a,z21<a S*J J- au Ct w C <br /> 13. Are there any water wells on this parcel or adjacent properties? YES )3 NO� <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public well rt <br /> Private Well ft <br /> Irrigation Well It. 1 <br /> Monitoring Well ft <br /> Other rt <br /> f <br /> if <br /> 14. Will the tanks)pending closure be replaced with an aboveground or undergruimd storage tuNs)?YESIINO[) <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. Ir the party designated below is different than the permit applicant;e.g.property owner,the party must aclmawledge <br /> this responsibility for the billing by signature and date below. !! <br /> Name M �� <br /> E <br /> Mailing Address S 5 ' <br />! Day Phone Number <br /> Signature Title Date <br /> 'i <br /> �h <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />