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12. What is the depth to groundwater? U0 KvrOW N <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? <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 />YES[ ] NO XI <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? <br />YES[ ] NO(X <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour <br />minimum permit payment per tank. If the party designated below is different than the permit <br />applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by <br />signature and date below. <br />Name <br />Mailing Ad <br />Day Phone <br />rI <br />I <br />r <br />4,91 <br />C--/t,�- <br />Sh0- �ZOo <br />/46 CAIT- <br />1/-az-o6 <br />y270S <br />Signature \ Title <br />EH 23 046 (Revised 8/9/06) <br />