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12. What is the depth to groundwater? Ut/lGNO/w//J <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ["0 <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Weil tC <br /> Private Well tt <br /> Irrigation Well ft <br /> Monitoring Well ft. <br /> Other tt <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tauk(s)?YES NO[i <br /> i <br /> m <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time Mended beyond 3 hour `nimum permit payment <br /> per tank. If the party designated below Is different than the permit appOcant,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> NamegobV <br /> s!)) <br /> Mailing Address `Z 7 94-4--e ,O/9,YoNn coq. 95-2�4D <br /> Day Phone Number ,0 Z <br /> �/SpFy�yTiT1V/�l4 �/al"8 <br /> Signature Title Date <br /> EH 23 046(Revised 10/19/98) Page 6 <br />