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N./ - <br /> 12. What is the depth to groundwater? <br /> Describe the source of information_ <br /> 1:. Are there any water wells on this parcel or adiacent properties? YES <br /> TYPE OF WELLS DISTANCE TO TA-,y <br /> Public Well ft- <br /> Private <br /> tPrivate Well I ft <br /> Irrigation Well fL -� <br /> Monitoring Well I ft <br /> IIOther I it <br /> ill. Will the tank(s) pending closure be replaced with an unde.around storage tank(s)". YESXNO( <br /> 1=. Indicate the responsible oarty to be billed for additional PITS-EIM staff time e,pended beyond = hour minimum <br /> permit oavment per, mnk. If the part designated below is different than the oe mit applicant a g. orooer-y <br /> owner, the part. mus ac:nowiedge this responsibility for the billiag by signature and date below. <br /> `lame E 1 J Ti- III r-+ y� <br /> Mailing Address 2 lr3.s �'��c 9 w 2 �,�-� ��i-iy -2 5�- , P oyL <br /> Day Phone Number ( 2 0 cr <br /> 7 <br /> y�J e c C O0,0 6. 9 <br /> � ature 'QQ a / Title �I- D e <br /> 43Y't K �r0-1,It'L fv-oJ e r f I,,-CL geY- <br /> EH 2; 046 (Revised 9/11196) Page 6 <br />