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12. What is the depth to groundwater? <br /> Describe the source of inform.yat.i,on: <br /> CSS/DM eJ" <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO j <br /> TYPE OF WELLS DISTANCE TO TANKSM <br /> Public Well it. <br /> Private Well fL <br /> Irrigation Well rL <br /> Monitoring Well ft. <br /> Other <br /> it <br /> 14. Will the tanks pending closer be laced with a abov m r and stora a tanks . YE NO j <br /> O P II P g <br /> O' <br /> T6njCl [tee! AIS<ad}/ 6fn I`e/!etc w A Le 'Pe..� �IGJ <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 applleant, eg. property <br /> owner, the party //must acknowledge this responsibility <br /> for the billing by signature and date below. <br /> Name G.6�I 0 t 6-t CGC ✓GW� �i S //I`C <br /> Mailing Address 13o s u i y-vF- e P� t Lod, Lek._J cyayo <br /> Day Phone Number f -C9 331 - 'lel/9 <br /> Q t_ a i //-OA? <br /> Si Title Date / <br /> G � G2czZ�/'ICLLy� <br /> � Q SC� �CGG�C � w <br /> �/ <br /> ��G'l'L'l <br /> EH 23 046 (Revised 9111196) Page 6 -- <br /> Z0 39Vd -G1N3WNOHInN3 1H9IaM ZSTSZ6860ZT 6Z:60 L661/01/ZT <br />