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12. What is the depth to groundwater? '�/ bSQ <br /> Describe the source ofinformatio <br /> 1 ` � tA� CTtI SIP , <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 v ft <br /> Irrigation Well 0 ft <br /> Monitoring Well ft <br /> Other G ft <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOY <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant a g. property <br /> owner, the party must acknowledge this responsibility for the.billing by signature and date below. <br /> Name .-TD e & <br /> Mailing Address �, n, &OX ' <br /> Day Phone Number (�� L, D <br /> reTitle Date <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />