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12. What is the depth to groundwater? 2-0 <br /> Describe the source of Mornmation: <br /> 6?R = 661 [>py tL[�- ( VJ s1TEy�'w't 1.�REG�ara�c-{ T cvr� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES <br /> --------------------- <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well <br /> Private Well ft <br /> IrrigationWell ft <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[j NO(] <br /> 15. Indicate the responsible party to be billed for additional PHS-SHA staff time expended beyond 3 hour minimum pelt 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 KH <br /> Mailing Address '92 61 , of i e'J e L.V D rI- U M T24 <br /> Day Phone Number( -707 _) 7(a5 - 1&(C0 <br /> 0-1011- S - z `b <br /> Lure Title Date <br /> EH 23 046 (Revised 08113199) page <br />