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12. What is the depth to groundwater? 2 <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO bQ <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well fr. <br /> Monitoring Well fr. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage <br /> tank(s)?YES[]NO[( <br /> 15. Indicate the responsible party to be billed for additional EHD 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 <br /> owner,the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name ROh SAnAv.naf1 IS"qveH .' =�✓es� re }, LLL <br /> V J n <br /> Mailing Address I BG+3$ t`, CoW- o0o). s e Jl <br /> Day Phone Number( VI lP 0-7 - 9 z a y <br /> �hs�� 2 3. 1a�lo <br /> Signature Tie ate <br /> EH 23 046(Revisedl0/16/03) Page 6 <br />