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12. What Is the depth to groundwater? J\PJ <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? U N 1<0 O W O YES (] NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> gation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]NOd <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 W.A CRA G Lro C— IS <br /> Mailing Address 21 �) Te <br /> Day Phone Number <br /> 10- � ..7 <br /> Signature Title Date <br /> EH 23 046 (Revised 08/13/99) Page 6 <br />