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What is the depth to groundwater? PPle c x ;1 ri ti 7 E- J. V /" T: 2= 6!-- q <br />Describe the source of information: is <br />C'/4i 1 ail' i���Gs?TS <br />13. Are there any water wells on this parcel or adjacent properties? YES NO ( j <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />I c. A, rill <br />C-. ^4 S F <br />14.. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES(4 NO[ ( <br />5. Indicate the responsible party to be billed for additional PHS-EHD 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 jet ? h E' P/ <br />Mailing Address C. <br />Day Phone Number H 3 y 3 <br />i <br />Signature Title 17 Dafe - <br />0 23 046 (Revised 08/13/99) Page 6 <br />