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12. What Is the depth to groundwater? E4xilwl J S e <br /> Describe the source of Information: <br /> CKP71-0 6ra4�J wtrFer mAP c4 �c" DEP21 craLna wa+- r !f1i?! n9a <br /> QIl 41tD <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ]] NX <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well It. <br /> Private Well ft. <br /> Irrigation Well f< <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[]N0 <br /> \ <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour mbtim/umper lit payment <br /> per tank. it the party designated below Is different than the permit applicant,e.g.property owner,the party must acknowledge <br /> this responsibility four the billing by signature and date below. <br /> Name �Vfl T-6,1 (0( ,) PQa n <br /> Mailing Address -7 A 5To(KT0fJ C/T 9SzG7 <br /> Day Phone Number(-70-7 , 24 9 - 23 7 0 <br /> . ti P o/o <br /> Signature Title Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />