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12. What Is the depth to groundwater? U,dlGsuOt�J� <br /> Describe the source of information: J <br /> 13. Are there any water wells on this parcel or adjacent properties? YES I"0 ll <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well IL <br /> Private Well tL <br /> gation Well ft <br /> Monitoring Well ft. <br /> Other It. <br /> 14. Will the tai*s)pending closure be replaced with an aboveground or underground storage tankls)?YESp�NOI{ <br /> mini 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour ��'nimum 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 /> Name gds/,_ 6w–/iCS <br /> MalUngAddress GZ7 B�C� /g�a°o�✓p �^ '¢y—�D� �D <br /> Day Phone Number f y l X33- 03o z <br /> Signature Date <br /> EH 23 046(Revised 10/19/98) Page 6 <br />