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da (Do <br /> 12. What Is the depth to groundwater? <br /> Describe the source of Information: <br /> 13. Are there any water webs on this parcel or adjacent properties? YES (( NO(a <br /> TYR OF WEUS DISTANCE TO TANE9(S) <br /> Public wen tt. <br /> Private Well tt- <br /> irrfgation Well tL <br /> Monitoring Well ft. <br /> Other ft. <br /> 14 Will the tanks)pending closure be replaced with an abovegromd or underground storage tadWs)?YP.9 0011 <br /> 15. Indicate the responsible party to be billed for additional P9&EDD stall time expended beyond 3 hour minimum permlt Payment <br /> per tank. It the party designated below is different than the permit apPntant,e.g.Property owner,the Party most acknowledge <br /> this responsibility for the billing by slgnatnre and date below. <br /> Name La,- a4— V. w <br /> MaltlngAddress S-a39 "A,ek"le• -424 <br /> Day Phone Namber( 910 1 tesi v -""1 <br /> l � <br /> _ Awn.. p.c 94 <br /> 9lgnataro Title Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />