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12. What Is the depth to groundwater? 11i &S <br />Drbe the source of Info on: <br />JFLt Pu LLF ��� 1_ � res <br />13. Are there any Water Wells on this parcel or adjacent properties? YES NO C <br />TYPE OF WELL" DMTAXCE TO TAN UM <br />Public Well n, <br />Private Well [t, <br />Irrigation well tL <br />Monitoring Wen tc o4 m e t o s M N , -FC fZ ► & <br />other ft. C)Q 6 i T� <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YESKNO( j <br />15. Indicate the responsible party to be billed for additional PHS•BHD staff time expended beyond 3 hour minimum 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 /V <br />Malling Address y, a 0l I1 % /9 CZ—. _S' U / T D <br />Day Phone Number ( �, 14 ) �,, S�-,/ .,L �.6 O % <br />2211, d % <br />tare Title Date <br />EH 23 046 (Revised 08113/99) Page 6 <br />