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12. What is the depth to groundwater? LN L L) 1Al <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [] NOX <br />TYPE OF WELLS <br />I Dl[STANCE TO TAWS(S) <br />Public Well <br />ft <br />Private Well <br />& <br />Irrigation Well <br />ft. <br />Monitoring Well <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ I NOXI", <br />15. Indicate the responsible party to be billed for additional PHS-Estaff 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 />Name S, <br />Mailing Address L- I �, L -L b242.. <br />L <br />Day Phone Number 4- <br />L2::� � N I FO a 0 JL� N ZR / , <br />Signature Title Date' <br />EH 23 046 (Revised 9/11/96) Page 6 <br />