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12 What Is the depth to groundwater? L22i <br /> Describe the source of information: <br /> �i BIZ I/At alyl&tJ bd E �- <br /> 13. Are there any water wells on this parcel or adjacent properties? NO(J <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well it. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well Q ft. <br /> Other R <br /> 14. WHI the tanks)pending closure be replaced with an aboveground or underground storage tank(s)?YES(!N <br /> 15. Indicate the responsible to be billed for additional expended beyond 3 hour minim/ma_ 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 0[9&t?15Q Ivy I CAI-O I9-L <br /> Mailing Address f4dn IN I LLIA-MS 5T-, 1r— 9 P-Q <br /> Day Phone Number(M(k,L <br /> t.�_. 2 3 Lvbd I 1 L4d NI e6d, J 1 GAC- <br /> Si4 t v Tltie Date <br /> EH 23 046 (Revised 10/19/98) Page 6 <br />