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12. What is the depth to groundwater? <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES PO NO) 6, <br />TYPE OF WELLS <br />I DISTANCE TO TANKS(S) <br />Public Well <br />BL' .-/UU <br />ft <br />Private Well <br />/ 00, rt. <br />ft <br />Irrigation Well <br />/A <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 underground storage tank(s)? YES[ [ NOPC <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 <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name b4C, <br />Mailing Address qW 6K /i (Ota ,r p C4 C1S 3S � <br />Day Phone Number <br />/l�C �/��L— Prttstlrtf x!-/2-97 <br />Signature Title Date <br />EH 23 046 (Revised 7/10/96) Page 6 <br />