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12. What is the depth to groundwater`` <br /> r <br /> Describe the source of information: C GSL U' <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [1 No`Is` <br /> TYPE OF WELLS DISTANCE TO TANSSP <br /> Public Well ft <br /> Private Well ft. <br /> Irrigation Well it <br /> Monitoring Well ft. <br /> Other n- <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[j NO[j <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit payment <br /> per tank. If 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 /> Name <br /> Mailing Address j=� f � - <br /> � '" , rte <br /> Day Phone Number <br /> - <br /> ttue Title Date <br /> EH 23 046 (Revised 08113199) Page 6 <br />