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12. What is the depth to groundwater? OW Q <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [ ] NOX <br />(j1 N 144,10 W N, <br />TYPE OF WELLS <br />I 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 />14. Will the tank(s) pending closprc be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[ ] <br />15. Indicate the responsible partytobe billed for additional PHS-EHD 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 <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Mailing Address 1:31-M U iJ I d s (L(%. O <br />Day Phone Number ( 610 ) COO °[ GOO <br />Signature v Title Date <br />EH 23 046 (Revised 9/11/96) Page 6 <br />