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12. What Is the depth to groundwater? <br /> Describe the source of informatlom <br /> lJ. Are (here any water wells on this parcel or adjacent properties? <br /> YES [ ) NO [l� <br /> TYPF, OF WELLS DISTANCE TO TAM(S) <br /> Public Well n. <br /> Private Well n. <br /> Irrigation Well n• <br /> hlmiltoring Well fl. <br /> Other M <br /> H. Will the lnnk(s) pending closure be replaced with an aboreground or underground storage tank(s)? YES[ NO[ ) \ <br /> 15. Indicate the responsible party to be billed for additional PIIS-EIID staff time expended beyond J hour minimum <br /> permit pnyment per tank. If the party designated below Is different thnn the permit applicant, e.g. properly owner, <br /> the party must acknowledge (his responsibility for the billing by signature and dale below. <br /> Name Z � C/ C U� rn /b I / <br /> Mailing Address / � � ( r(J) IVrC C1 ` i 1 V(L , L C C1 i LA, 0 <br /> Day Phone Nu r ( � 7 ��8 S �''�[ <br /> 66� (' C 7 -0 iLl <br /> Sigunture Date <br /> Page 6 <br />