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12. What is the depth to groundwater? <br />3 1 Fc c1" w lit; carntNa <br />Describe the source of Information: <br />S Z-® l O — c C C Av1 <br />� V i PGI i s Gro S Sn ®L %A c► 1 9 <br />n <br />13. Are there any water wells on this parcel or adjacent properties? YES [I NO <br />IK <br />14. Will thetank(s) pending closure be replaced with an aboveground or gnilerground storage tank(s)? YES NO[ } <br />15. Indicate the responsible party to be billed for additional PHS—EPHS-ERD staff time expended beyond 3 hour minimum <br />penult payment per tank. If the party designatedlow is different than the permit applicant, e.g. property owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name 1 /(.� ACd I2 v i,o®7L vi/c S r ='f? G <br />Mailing Add ss _ ("� �. Q..E& t/nbr7 7 ca, 9Z.LP- <br />Day Phone Number L,S O 7— Sb Q <br />� (�-- ---, <br />.Y C,`fro <br />S natu Date <br />Page 6 <br />DISTANCE, TO TANKS(S) <br />Public Well <br />Private Well <br />Irrigation Well <br />Monitoring Well <br />14. Will thetank(s) pending closure be replaced with an aboveground or gnilerground storage tank(s)? YES NO[ } <br />15. Indicate the responsible party to be billed for additional PHS—EPHS-ERD staff time expended beyond 3 hour minimum <br />penult payment per tank. If the party designatedlow is different than the permit applicant, e.g. property owner, <br />the party must acknowledge this responsibility for the billing by signature and date below. <br />Name 1 /(.� ACd I2 v i,o®7L vi/c S r ='f? G <br />Mailing Add ss _ ("� �. Q..E& t/nbr7 7 ca, 9Z.LP- <br />Day Phone Number L,S O 7— Sb Q <br />� (�-- ---, <br />.Y C,`fro <br />S natu Date <br />Page 6 <br />