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12. What is the depth to groundwater? )ILL <br /> Describe the source of information:� 74-a' ZoL ti o a ':e� <br /> 13. Are there any water wells on this parcel or adjacent properties? YES �N,O" [_ J <br /> TYPE OF WELLS F�1STANCE 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[ J 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 <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name �e-A%IeA `✓YJ I +' iZV ,JI) <br /> Mailing Address <br /> Day Phone Number (L (�al <br /> tin <br /> Signature Title Date <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />