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• i <br /> 12. What Is the depth to groundwater? tp-F- <br /> Describe the source of info rma on: <br /> PC+ glE Qen:Amep 5 <br /> 13. Are there any water wells on this parcel or adjacent properties? YESK NO 1 j <br /> TYPE OF WELLS DISTANCE TO TANgS) <br /> Public Well ft. <br /> Private Well ft. 5 E <br /> Irrigation Well ft. <br /> Monitoring Well ft <br /> Other It <br /> ld. Wtll the tank(s)pending clostue be replaced with an aboveground or underground storage tank(s)?YES[j N0g <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 G 4-t-- <br /> Mailing Address 7�-7N o((,,2.i h Wt e- �- r L4-L � (��-L i ClZ-IL CA <br /> Day Phone Number( -t 7/t �4-5( <br /> Si ature Title D eat <br /> EH 23 046(Revised 08/13/99) Page 6 <br /> l <br />