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12. What is the depth to groundwater" <br /> v1 V,n o-141� <br /> Describe the source of information: <br /> 13, Axe mere any water wells on this parcel or adjacent properties? YES � � <br /> NO <br /> TYPE of WEU S DISTANCE TO TANKS(S) <br /> Public Well M <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> OtherM <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES NO[ 1 <br /> 15, 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 must acknowledge this responsibility for the billing by signature and date below. <br /> Name `#-�� L l�C-�iILtZ1jl7L— <br /> Mailing Address <br /> Day Phone Number {��� } <br /> XJ 7 <br /> Date <br /> Signat <br /> Page 6 <br />