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12. What is the depth to ter? <br /> Describe the son=of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES ]] NO[] <br /> Tin OF Wnu DISTMC11 TO T <br /> Public Well ft. <br /> Private well tL <br /> on Well it <br /> Monitorin Well ft. <br /> Other it. <br /> 14. Will the UuMgs)pending closure be replaced with an abovegroundorunderground storage tank(s)?YE"N <br /> 15. Indicate the responsible party to be billed for additional PHS-11111)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 4 L 1b cs 15;, Crov� <br /> Mailing Address Y- N, to C Qy w-P, <br /> Day Phone Number -101 ) '7 6 S 460 <br /> 4LL,4& sd <br /> Si tare Titre Date <br /> i <br /> EH 23 046(Revised 08/13/99) Page 6 <br />