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12. What is the depth to groundwater? 55 FEFt ' <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ( I NO/ <br /> I� <br /> TYPE OF WELLS DISTANCE TO TANKS(S) 4' <br /> Public Well ft- <br /> Private <br /> tPrivate Well ft. <br /> Irrigation Well ft i <br /> t <br /> Monitoring Well ft. <br /> Other ft <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ I Nol <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 party must acknowledge this responsibility for the billing by signature and date below. <br /> Name -ARI-A, <br /> Mailing Address C � ' rti ,<?r ► � �j <br /> Day Phone Number �'+7 <br /> i <br /> J-A 11 <br /> Signature Title Date <br /> - I <br /> i <br /> I <br /> i <br /> I <br /> I <br /> EH 23 046 (Revised 9/11/45) Page 6 <br /> i <br />