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12 What is the depth to groundwater? APP[QA1 FE cA ASG <br /> Describe the source of Information <br /> Lnes cf 'Cei- ,1 ELP 6(0 �dwa+erg — -'Oul A 1996 <br /> 13. Are there any water wells on this parcel or adjacent properties? YES I] NOI Y <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft <br /> Private Well ft <br /> Irrigation Well rL <br /> Monitoring Well ft <br /> Other ft <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage t"s)?YES[]N0 <br /> 15. Indicate the responsible party to be billed for additional PHS-EDD 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 most acknowledge <br /> this responsibility for the Milli�ng" by signature and date below. <br /> An <br /> Name r T_c rpT ice'n n Ole �H 2 <br /> MallingAddress 2 �FSb rhP(1SGtif liVO 5 TcCI:a,) C 952C7 <br /> Day Phone Number( oto ) y[,-1 /QA <br /> Signature V VTitle Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />