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12. What is the depth to groundwater? <br /> Describ the s u e of information: ((� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [�] <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 /O 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 PHS-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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name �e � ��-l{���Ac� t ��_ � � Ytc�_ ,G z�- <br /> Mailing Address5C� <br /> Day Phone Number <br /> re Date <br /> Page 6 <br />