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12. What is the depth to groundwater? <br />V Maw <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [I NO [ ] <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or undergroand storage tank(s)? YES[ ] NO[ ] <br />15. Indicate the responsible party to be billed for additional PAS-Estaff 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 />Name Re 9,v C. JsA.-,e s n <br />Mailing Address ILS -e+ k�:>,- / CA � N SRF <br />Day Phone Number( s/[7 ) 'iX6- ( C <br />(B1 :2 (Si o) Soh-/6P�— <br />Signature <br />Page 6 <br />/9z <br />Date <br />