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12. What Is the depth to groundwater? � k�9g L% Vl�{� • 2�1 CX I <br /> Describe the source of Information <br /> 13. Are there any water wells on this parcel or adjacent properties? YES�NO[] <br /> TYPE OF WELLS DISTANCE TO TANPS) <br /> Public Well ft. <br /> I <br /> Private Well 1t <br /> I <br /> Irrigation Well rC <br /> Monitoring Weil < 00 rt. <br /> Other — rL <br /> IL <br /> 14. Will the tanks)pending closure he replaced with an aboveground or underground storage tanlgs)?YES i NO(] <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. 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 signature and date below. <br /> Name '-\• l�iZV�c9c�? <br /> Mailing Address (g lr,7:—� L-C�� <br /> Day Phone Number Z U� <br /> Signature Title Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />