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12. What is the depth to groundwater? eA / i�N O w <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO,ft' <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft• <br /> Other ff- <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ I NOI 1 <br /> 15. Indicate the responsible party to be billed for additional PHS-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 <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> i <br /> Name Of. N o ( i f tea) G_ 0.1 <br /> Mailing Address <br /> Day Phone Number '( 09 <br /> natureTitle Date <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />