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12. What is the depth to groundwater? 7 t) 'Fe-e-+ <br /> Describe the source of information: <br /> (=loocl (ov*ml map a s Q co. F�61ra Wks•dtp+ <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ( ] NO QQ <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well fL <br /> Irrigation Well ft <br /> Monitoring Well fL <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YE,KJ NO( J <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 /> NameZ:9�42 &(-a nielo (oF aut_ Irw•) <br /> Mailing Address IaSGC�- Wil(OW Pass RJ • r twile- 4217 <br /> Day Phone Number <br /> t 4, Tosco tiHA. GLz3A'X <br /> 6116, <br /> a re Title GO. Date <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />