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1 _ <br /> ' 12. What Is the depth to groundwater? 2-© f 'FEF—T <br /> Describe the source of information <br /> G-t[Z�.GGi DRI�1-1N�-( W�siTE �Wul�.�/,9ReGDr��u,.lg .ce�rl� <br /> ' 13. Are there any water wells an this parcel or adjacent properties? YES (( NOK <br /> ' TYPE OF WELLS DISTVICE TO TANKS(S) <br /> Public Wed It. <br /> ' Private Well It. <br /> Irrigation Well ft. <br /> Monitoring Well I it <br /> Other <br /> it <br /> 1 . <br /> ' 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]NO(] <br /> 15. indicate the responsible party to be billed for additional PHS-SHD 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 billing by signature and date below. <br /> ' Name (*4- - <br /> ' Mailing Address <br /> Day Phone Number( 707 ) 7(¢S - 10(00 <br /> 8Tgat <br /> lure Title Date <br /> 1 <br /> ' EH 23 046 (Revised 08113199) Page 6 <br />