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What is the depth m groundwater? <br /> io - 12 <br /> Describe the source of information: 1 <br /> Pry-)i it s�y�`_/ } .ti 'cam ( ✓mss C�' E1 rJ ci''e--=) 12-2'2- 1ILi <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ 7 NO [ ( <br /> I I <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well f <br /> Irrigation well <br /> Monitoring Well M <br /> Other M <br /> . I <br /> 14. Will the tank(s) pending closure be replaced with an abovegroundandergroun storage tank(s)^. YES�f NO[ l <br /> In 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, eg. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> I <br /> Name I aid aso�a�es <br /> i <br /> Mailing Address 2ff So sv v--i'sP 31✓� y S H e 20 to <br /> Day Phone Number ( 9 1 tv 1 Io 3 C5 2 ti u N <br /> 10— <br /> Signature Date <br /> I <br /> k <br /> Page 6 <br /> ' f[ <br /> F <br /> f <br />