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n <br /> What is the depth to groundwater? jjj <br /> Describe the syyu a of information: <br /> E 16� /i I -6 All/ K'r —1✓fir cc S it l�/1 {�Tt ✓) /y"Wi <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ T <br /> rOther <br /> sLLS DISTANCE TO TANKS(S) <br /> ft. <br /> It. <br /> ll It. <br /> ell ft. <br /> /C 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-EIID 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 CVC"c- <br /> Mailing Address5 o <br /> Day Phone Number <br /> ure Date <br /> Page 6 <br /> Fr,,. <br /> L <br />