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12. What is the depth to groundwater? <br /> Describe the source of information: , <br /> Q,�ti►naf0 <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO <br /> I <br /> TYPE OF WELLS O STANCE TO TANES(S) <br /> Public Well it. <br /> Private Well it. <br /> i <br /> Lt <br /> rigadon Well 2 <br /> onitoring Well rL <br /> her j <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]NOj] <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD 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 must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name SY)(A1 tnWVff Mxl.Q <br /> MaiDngAddress q)b N &Oa, Tway U/P Stfan Cid g690 <br /> Day Phone Number( �� ) �1 -�Iff1 <br /> b6 ` /A 6146a<—, �r�l� /,�? -�? J <br /> Signature Title Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />