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12. What is the depth to gudaterT <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [ ] NO [ ] <br /> TYPE OF W]RIJ.SCI:,TOT (S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will thetank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YESDO NO[ ] <br /> 15. Indicate the responsible party to be billed for additional PHS-Estaff time expended beyond 3 hour minimum <br /> permit paymenttank. If the party designated below is different than the permit appll t, e.g. property owner, <br /> the partyc owl a this responsibility for the billing by signature and date below. <br /> Marne , 1 <br /> Mailing Address 564q A&L& * 4' Gts C <br /> Day Phone Number LP ) <br /> Sign&m 1 ® ® . T Date <br /> Page 6 <br />