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12. What is the depth to groundwater? UP k N p"`1 d <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [j N010 <br /> TYPE OF 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 abovegroun r underground storage <br /> tank(s)?YESK NO[] <br /> 15. Indicate the responsible party to be billed for additional EHD 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 <br /> owner,the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name Z ktt"4S <br /> Mailing Address c &4- R <br /> Day Phone Number( -360 ) 6 66 - s y6 <br /> Signature Title Date <br /> EH 23 046(Revisedl0/16/03) Page 6 <br />