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P. 7 <br />12. What Is the depth to groundwater? �Q ,. _ ® 14 <br />Describe the source of Information hrIA, FA) <br />U Are there any water wells on this parcel or adjacent properties? YES /NO ( j <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />n <br />Private Well <br />Irrigation Well <br />ft, <br />Monitoring Well <br />ft. <br />Other <br />it <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ j NX <br />15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour 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 %0. <br />MallingAddress Z60-0.- <br />f %��, S/ �/F`i0 L L�,�jf✓/�2� C%g - �7� 7�e <br />Day /Phone Number <br />-r14- L (7- Z--2,t4� Ffmp-750 <br />Title bate <br />H 23 046 (Revised 08/I3/99) Page 6 <br />