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12 <br />13. <br />14. <br />IN <br />Whnt Is the depth to g omidwater? <br />1-7 <br />Describe the source of Infurnintiom <br />Are there any water wells on this pnrcel or ndjnceitt properties? <br />TYPE OF WILTS <br />DISTANCE TO TANIKS(S <br />Public Well <br />R. <br />Private Well <br />Irrigation Well <br />Monitoring Well <br />It. <br />Other <br />11. -1 <br />YES M NO [ I <br />Will the tnnk(s) pending closure be replaced with tun a1mvcgrovind or mideigroond storage tmik(s)? YEISJ I No[ I <br />Indicate the responsible party to be billed for n(lditional MIS-Ell"ID sinif time expended beyond 3 hour millimilm <br />permit payment per tank. If (lie pni-ty designated below is different than the permit npplicnitt, e.g. property omier, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name <br />Mailing Address <br />My Phone Number <br />Sigliftbue <br />1';igc 6 <br />E <br />