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12. What is the depth to groundwater? <br /> Describe the source of information: <br /> Y <br /> 13. Are there any water wells on this parcel or adjacent properties? YES f j NO E„ <br /> TYPE OF WELT :PDISTA�NGETO TANKS(S) <br /> Public Well ft <br /> Private Well ft <br /> Irrigation Well ft <br /> i t <br /> 33aaitoring well ft <br /> Other ft <br /> 14. W111 the ta*s)pending closure be replaced with an aboveground or underground storage tank(s)?YESf)NO[) <br /> 15. Indicate the responsible party to be blued for addltional 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,ems_property owner,the party must acknowledge <br /> . this responsibility for the bluing by siguature and data below. <br /> Name <br /> MailingAddress Ck-1Ytry Wa+ star- i? Gil 157-p Ce' <br /> Day Phone dumber{ ZOq ) 4 (a U, <br /> oWMei✓ <�12-7 1.11 <br /> Signature <br /> -lit.1e Date <br /> �k <br /> EH 23 &46 (Revised 14119198) Page 6 <br />