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. r <br /> 12. Wbat is the depth to groundwater? ,'No <br /> Describe the source of Information: <br /> 13. Are there any water wells on this parcel or adjacent properties?. YES [] NO ff <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well fi <br /> Private Well ft. <br /> ,k <br /> Irrigation Well .. tt. <br /> i <br /> Monitoring Well ft_ <br /> Other A ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)?YES[]No[] <br /> 15. Indicate the responsible party to be billed for additional PHS-E®staff time expended beyond 3 Dour 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 Waterfront Yacht Harbor <br /> Mailing Address 4505 Precis'si Lane Suite B Stockton CA 95207 <br /> F <br /> . <br /> Day Phone Number( 209 ] 473-200]. <br /> SlguatUr Tttie nate <br /> EH 23 046 (Revised 1011919$) Page 6 <br />