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1e. What is the depth to groundwater? Gt <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ NO [ ] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ( ft. <br /> Private Well ft. <br /> Irrigation Well I ft. <br /> Monitoring Well I ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] 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 '-Vel-et,h ys C <br /> Mailing Address p v, a 0 if S�'� e -P(e4 s <br /> Day Phone Number ( 'q2-,!� ) 114 J�" r <br /> <; ethpRb.— <br /> I✓ . <br /> Signature Title Date <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />