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J <br /> MV <br /> at is the depth to groundwater? / <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent gnvipml les? YES 17 NO <br /> [ <br /> ,TYPE ON WELI S DISTANCE.To TANKS(S) <br /> Public Well It. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other It. <br /> 14. Will the tank(s) pending closure be replaced with an nboveground or underground stornge tank(s)? YES[ ] NO[ ] <br /> IS. Indicate the responsible party to be billed for additional PIIS-EIID staff time expended beyond 3 hour mhdmum <br /> permit payment per (ank. If the party designated below is different Man the permit applicant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and dale below. <br /> Name <br /> Mulling Address C) <br /> Day Phone Number ( v�-O <br /> Sigw n rc Dal <br /> Page 6 <br />