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12. What is the depth to groundwater? l 11 <br />Describe the source of Information: <br />13. Are there any water wells on this parcel or adjacent properties? YESX NO j ] <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />14. Will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? YES( ] ND( ] j 41 <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 <br />Mawn <br />Day Phone Number ( '?U ) & 25--gY vy <br />Signature Title/Date <br />EH 23 046 (Revised 08/13/99) Page 6 <br />