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12. What is the depth to groundwater? <br /> Describe the source of information: <br /> elf <br /> 13. Are there any water wells on this parcel or adjacent properties? YESX NO[] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well fk <br /> Irrigation Wellft. <br /> C <br /> MonitoringWell 2 v & <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage <br /> tank(s)?YES[]144 <br /> 15. Indicate the responsible party to be billed for additional 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 /��� CV`GhQKf <br /> Mailing Address � <br /> Day Phone Number <br /> Signature Tie ate <br /> EH 23 046(Revised l0/16/03) Page 6 <br />