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12. What is /e^depth to groundwater? I <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 DISTANCE TO TANKS(S) <br /> Public Well ft• <br /> Private Well ft. <br /> IrrigationWell n <br /> Monitoring Well n• <br /> Other M <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ I NO,( <br /> staff is. Indicate the responsible party to be billed for additional PHS-EHD 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 — car-d sc hr e+de!' <br /> Mailing Address r' ^ 13 —O'R c; O h iCO. CA 9 5 9 r -3 <br /> Day Phone Number �1 l R9g to y <br /> ,44 Date/ _ 4-5--9 to <br /> Signature <br /> Page 6 <br />