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11 What Is the depth to groundwater? <br /> Describe the source of Information: Mr <br /> 13. Are there any water wells an this parcel or adjacent properties? YES I I NO' ' <br /> LTUEU WELLS DISTANCE TO TANKS(S) <br /> Public Well ft, <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft, <br /> Other ft. <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 PIIS-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 4g y')'� <br /> Mailing Address <br /> Day Phone Number <br /> Signa a Title Date <br /> EH 23 046 (Revised 08113199) Page 6 <br />