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12. What is the depth to groundwater? <br />Describe the source of Information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [ 1 NO[ ] <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft <br />Other <br />fL <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[�� <br />15. Indicate the responsible party to be billed for additional PHS -EDD staff time expended beyond 3 hour minimum permit payment <br />per tank. It 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 />Namet1� c�e4wlAi//nl/9 <br />Mailing Address <br />Day Phone Number',L , - �( )'%S/—SS-2c) <br />Signature Title Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />