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12. What is the depth to groundwater? <br /> Ded1h to grDundaNe 1h 'HV Utc m 1i os 1W sti apoeoxr TM 1 T, So FT <br /> Describe the source ofi Information: 1 <br /> ?Cysrm 'AmA S� joa$u ih Qw�w <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO [ ] <br /> TYPE OF WELLS J DISTANCE TO TANKS(S) <br /> Public Well 'Ay�K ft. <br /> Private Well v o1 SO It. <br /> Irrigation Well ?CO R. ngT <br /> Monitoring Well u 6 n• <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOXj <br /> 15. Indicate the responsible party to be billed for additional PIIS•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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> NameSee Cover klter 'T-tr-m 10) <br /> Mailing Address <br /> Day Phone Number ( 1 <br /> Signature Date <br /> Page 6 <br />