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12. What is the depth to groundwater? <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well It, <br /> II <br /> Private Well It. <br /> E <br /> ation Well ILtoring Well ttr ft. <br /> 19. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NOI ] <br /> 15. Indicate the responsible party to be baled 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 k S offA t <br /> MallingAddressS�� ECJ +/ftI_t_ r2YS2�t> <br /> Day Phone Number ( <br /> i <br /> i J � <br /> C (lei <br /> Signature Title Date <br /> i <br /> i <br /> EH 23 046 (Revised 10/ 19/98) Page 6 <br />