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x <br /> 11 What Is the depth to groundwater? <br /> Describe the source of information: <br /> 13 <br /> M Are there any water wells on this parcel or adjacent properties? YES [I NOW-' 1 <br /> ' I <br /> i <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> i <br /> Public Well [t. <br /> 1 <br /> Private Well ft. <br /> Irrigation Well ft. <br /> 1 <br /> Yonitering Well ft <br /> Other ft. <br /> 14 Will the tanks)pending closure be replaced with an aboveground or underground storage tauXs]7 YES[]NOW <br /> 15. Indicate the responsible party to be billed for additional PHIl <br /> 3-FHD staff time expended beyond 3 hour nmum permit payment <br /> per tank. If the party designated below is different than the permit applicant_,e.g.property owner,the party must acknowledge <br /> this responsibility for the billing by signature and date below. <br /> Name - <br /> g�� <br /> Mailing Address <br /> Day Phone Number Z:? <br /> 1 <br /> signature Title Date <br /> 1. <br /> EH 23 046(Revised 10/19/98) Page 6 <br /> h <br />- f <br />