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12. What is the depth to groundwater? <br /> 20 Fr-- T <br /> Describe the source of information: <br /> E- 5SR�---SLEM <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ I NO [ ] <br /> UNKNOWN <br /> TYPE OF WE11S DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <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, ] NO[ <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 owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name S eNI t�Ee2►NG' <br /> Mailing Address � SU OIL * 303, L�F <br /> Day P ne Nu ber �J L- 3, -'17 7, ��79� <br /> ature Date <br /> Page 6 <br />