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yybat is the depth to groundwater.? lao �'eesiL <br /> Describe the oarce of iafOf= <br /> ttC Gcwl ge4Y" ,S S fa 1 Fl. r <br /> 13. Are there any water wells on this parcel or adjacent properties? YES f ] NO <br /> TYPE OF WELLS DWANCE TO TANIGS(S) ;f <br /> Public Well fL <br /> Private Well ft_ i{ <br /> Irrigation Well & j <br /> Monitoring Well ft, <br /> Other & <br /> p <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or�andergroand storage tank(s)? YES( I NOX <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 <br /> owner, the parry must acknowledge this responsibility for the billing 6v signature and date below. <br /> 3I <br /> I Name <br /> Mailing Address C 4 Felne, kA. i':jp (L �b, fSMk 57705,& AIddecA6 Cpl 1535 <br /> Day Phone Number ( ZOrf <br /> Signature J Title ,J. l late <br /> ;I <br /> 'r <br /> i <br /> �9 <br /> i <br /> EH 23 046 (Revised 7/10/96) page 6 <br />