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11i16i98 17:23 N0.108 D04 <br /> 12. What is the depth to groundwater? gay �`/1 ` �GLt4lL►4--�G�� l <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties° YES NO <br /> TYPE OF WELLS DfSTAIYCE TO TANKS(S) <br /> Public Well jf ft <br /> Private Well (/ �AA n• <br /> Irrigation Well ? ft. <br /> Monitoring Well JU ft. <br /> Other <br /> 14. Will the tank(s) pending closure be replaced with an abovegroaad or aadergrnand storage tank(s)? YESO�`NOI 1 <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time eXpeaded beyond 3 hour minimum <br /> permit payment per tank. if the party designated below is different than the permit applicant, eg. Property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name a ,,�rV(ct M �� Rdth <br /> Mailing Address . 075 g ' � G �OC.�C10M� 9✓�t,5 <br /> Day Phone Number (72 <br /> SI Title Date <br /> EH 23 046 (Revised 9111196) Page 6 <br />