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12. What is the depth to groundwater? en <br />Describe the source of information: <br />1�oi� <br />13. Are there any water wells on this parcel or adjacent properties? YES k] NO [I <br />=TYPEF WEI,1S <br />DISTANCE TO TANKS(S) <br />Public Well <br />fL <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other ' <br />fL <br />14. Will the tank(s) pending closure be replaced with an aboveground or and mad storage tank(s)? YES[ ] NO [X] <br />15. Indicate the responsible party to be billed for additional PHS -EEM 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 owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name <br />Mailing Address 975 S. Fairmont Avenue, Lodi, CA 95240 <br />Day Phone Number ( 2 0 9 ) 3 3 4— 3 4 11 <br />Sienatdre <br />o�AS � A-3�, -2z <br />Date <br />