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12. What is the depth to groundwater? 540 't�O /'F f <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO/ <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage <br /> tank(s)?YES[] NQ(< <br /> 15. Indicate the responsible party to be billed for additional 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 <br /> acknowledge this responsibility for the <br /> billing by signature and date below. <br /> Name /g`/J,Bs✓/' /�d7 �� L L <br /> Mailing Address �t> y�i� 16g, / cs <br /> Day Phone Number( ) -3-3 54 `'T /I <br /> i afore Title /Datel <br /> EH 23 046(Revised l0/16/03) Page 6 <br />