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12. What is the depth to groundwater? Anpf l3X �n <br /> Describe the source of information: <br /> Trnal(n <br /> 13. Are there any water wells on this parcel or adjacent properties? YES p{ NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well 25 0 ft <br /> Irrigation Well 30C> it <br /> Monitoring Well ft <br /> Other ft <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[ANO[] <br /> 15. Indicate the respousibie party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If the party designated below Is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility for the bWiug by signature and date below. <br /> Name ACJ �carLl, ��, A r`` J-nc . II <br /> Malllng Address �o�/ t5 �e ()f l e5 ��c( )-o c(c, <br /> Day Phone Number( ) '5 3 $ 77 5 1.t0? 46 j g4 5{f <br /> Ufa re TI a Date-1 <br /> EH 23 046 (Revised 08/13/99) Page 6 <br />