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12. What Is the depth to groundwater? <br /> o <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES )) Np f <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well It. <br /> Private Well M <br /> Irrigation Well it. <br /> Monitoring Well tt <br /> Other M <br /> 14. Will the tank(s)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 stall time expended 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 <br /> by signature and date below. <br /> Name C. ( C ' V / 72LddL ILLS. P6,07. <br /> Mailing Address p2Q �/[ /�Cv i�L (,/. C/— 5 z <br /> Day Phone Number 2 <br /> 3!rel 0 6 <br /> Signature Title Date <br /> EH 23 046(Revised 10/19/98) Page 6 <br />