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I � • <br /> 12. What Is the depth to groundwater? AQ 7-6 <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [l N <br /> TYPB OF W>3LL9 DIBTAAC81'fi TANS$( <br /> Public Well ft. <br /> Private Well ft <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft <br /> l <br /> 4 14. Will the taWgs)pending closure be replaced with an aboveground or undergrowd storage ta*&)?YES[1 NO[[ <br /> 15. indicate the responsible party to be baled for additional PIIS-END staff time expanded beyond 3 hour minimum permit payment <br /> per tank. if the party designated belowis 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 i,I i,5 4 0 `I' <br /> Qlalling Address 4 5( 1bac� c. Ott!G• I 5-b GL+DY-) 9 5 20'7 <br /> Day Phone Number( ZD q ) y 13 ' 7 - <br /> I <br /> l <br /> i �us�ne.55 <br /> g Title Date <br /> f <br /> i <br /> ' <br /> Page 6 <br /> EH 23 046(Revised 08/13/99) <br />