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12. What is the depth to groundwater' <br /> I /D <br /> Describe the source of Information: <br /> �CGEN L`Al /L.1( kUO.tXEa� q�A <br /> 13. Are there any water wells on this parcel or adjacent properties? <br /> YES [ 1 No <br /> TYPE OF WELIS DISTANCE TO TANRS(S) <br /> Public Well R <br /> Private Well R <br /> Irrigation Well fL <br /> Monitoring Well ft. <br /> Other fL <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ 1 NO <br /> 15. Indicate the responsible party to be billed for additional PHS-EIID staff time expended beyond 3 hour minimum <br /> Permit payment per tank If the party designated below is different than the permit applicant, e.g, property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name l NE CTT t/ DF V f17I'N ' /t MUL <br /> Mailing Address TQC y A- 10 Cj <br /> Day Phone Number <br /> 1012, l3 <br /> Signature <br /> Date <br /> Page 6 <br />