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12. What is the depth to groundwater? <br /> Describe the source of information: 1 <br /> �'/1 j c f� ��/04 r�/� Gc�Ct f�✓ l�'JD�(�j�i I�� L,u�-1 l S <br /> 13. Are there any water wells on this parcel or adjacent properties? NO <br /> TYPE OF WELIS I DISTANCE TO TANSS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well /+F � ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ ] <br /> 15. Indicate the responsible party to be billed for additional PIIS-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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name L( l �►a i))Cii �;)�. 1tT11� VU <br /> r1��QCc- <br /> Mailing Address Sas () 1 h'Icd Saf• NLpn �Y J fA X32- Cn <br /> Day Phone Number ( f q ) -58 3` f�y2 <br /> Signature Date <br /> Page 6 <br />