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12. What Is the depth to groundwater? Awl- /c Il <br /> Dese the,source of Information: <br /> �0l�ini �P��rpl�CrHdnJl�i'D�CC'� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES j j N0� <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft <br /> Private Well It. <br /> 1 irrigation Well it. <br /> Monitoring Well It. <br /> Other ft <br /> 19. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES[ <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minim✓✓`um 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 thebillingby signature and date below. <br /> Name �C,y --7 <br /> Mailing Address 5,90 —2 `06y Plod. �V L,/) 7 <br /> 953 <br /> Day Phone Number(z9 ,_ gal- /yoa <br /> I <br /> i <br /> Signature Title U Date <br /> i <br /> 1 EH 23 046(Revised 08/13/99) Page 6 <br />