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12. What is P groundwater' <br /> Def gibe tho u oC int rttaa>Xwfk �� /I ,e I p� r �py{J,t,E� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES NO [ <br /> TYPE OF WELIS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well 600 ft. <br /> Irrigation Well ft <br /> Monitoring Well ft. <br /> Other ft <br /> 11. Will the tank(s) pending closure be replaced with as abovegroand or undervMund storage tank(s)? YF-S[ ] NO[ <br /> 1�. 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 ym�ust acknowledge this responsibility for the billing by signature and date below. <br /> Name I v�DILL652-�> �k°L'' 11' 11 I /a <br /> Mailing Address gc;()u �. i6t-V20 �. kQylatCJbt bLd84 � , Ct,]-Z3 I <br /> Day Phone Number ( 2-09 ) q 02--1 T73 <br /> Signature U Date <br /> Page 6 <br />