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12. What Is the depth to groundwater? <br />13. Are there any water wells on this parcel or adjacent properties? YES [I X <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />it <br />Private Well <br />it <br />Irrigation Well <br />M <br />Monitoring Well <br />It <br />Other <br />it <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ j NO(�( <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minhum\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 billing by signature and date below. <br />Name &P �A)A j rtA ) — 10RCDfR7./ it ,,ifQA <br />Mailing Address <br />Day Phone Numb <br />Ct <br />Signature Title Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />