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12. What is the depth to groundwater? r <br /> Describe the source of information: <br /> /-/,VCS OF eP4',, - dtPTii r /ti <br /> 13. Are there any water weIIs on this parcel or adjacent properties' YES [ ) NO <br /> TYPE OF WELLS DISTANCE TO TANKS(5) <br /> Public Well It. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other <br /> 14. Will the tank(s) pending closure be replaced with,Cn abovegrmmn ,dr underground storage tank(s)IM YES[ O <br /> 13. Indicate the responsible party to he billed for additional PHS-EHD staff time expended beyond 3 h6 rr—tftinimnm <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 /> Name <br /> Mailing Address //3 <br /> Day Phone Number ( L09 ) 41'49 <br /> Signature Date <br /> Page 6 <br />