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12. What Is the depth to groundwater? <br /> Describe the source of Information: VIZ <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO if <br /> TYPE OF WELLS DLSTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well R <br /> Irrigation Well (t. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ) NO[ 1 <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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> � /7 <br /> Name / /&—x <br /> Mailing Address -0 &X �Z �� �� t f�/><uf � n/tn�� � y P 7.4 <br /> Day Phone Number 2 U(. <br /> �/ L/- <br /> Signature Dat <br /> Page 6 <br />