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12. <br />What Is the depth to groundwater? -6c) <br />Describe the source of 1�n[tormadon: <br />Unf35 1� 60,k I i v6PrH T� <br />13. Are there any water wells on this parcel or adjacent properties? YES [ 1 NO[ j <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft <br />Private Well <br />(IV rL <br />Irrigation Well <br />It <br />Monitoring Well <br />ft <br />Other <br />It <br />14. Will the ta*s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ 1 NO[ 1 <br />15. Indicate the responsible party to be billed for additional PHS•EHD 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 />Sign, <br />Name ob*F.J t (� L /n 1-tLt_, ii,c <br />Mailing Address S/'�— (ate SV -667— LSQA w.J 9 5320 <br />Day Phone Number ( Z'O% ► LP 3? ^ 770S– <br />EH 23 046 (Revised 10/19/98) Page 6 <br />