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12. What is the depth to groundwater? <br /> Describe the source of information: <br /> titres oG t is � H 7� l�/r7 /ti w�c�5 S?2(416 or- 1�q& f� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ I NO [ ] <br /> TYPE OF WEUS I DLSTANCE TO TANKS(S) <br /> Public Well M <br /> Private Well 75 fs. <br /> Irrigation Well EL <br /> Monitoring Well ft. <br /> Other ft <br /> 13. 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 PHS-EED 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 <br /> Mailing Address � STf( y SrhC:76T <br /> Day Phone Number <br /> Signature Date <br /> Page 6 <br />