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12. What is the depth to groundwater! <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties?YES [I NO( <br />nn'' ] <br />TYPE OF WEDS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)?YN:y(, NO[ ] <br />15. Indicate the responsible party to be billed for additional PHS -EBD 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 ✓ +S L i.)G f k)1, -Z:-12 I M, <br />Mailing Address �� �Ul%� I L ��U�i st) [� X03. i%� NIIT�I2L�� %� • 9�iS��r <br />Day Phone Number <br />Signature <br />x[33- 05-7 <br />Page 6 <br />O IZ <br />Dat <br />