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12. What is the depth to groundwater? O �� ® t' ® K <br />Describe the source of information: <br />t✓�/'�Q�% �NVIRO 2,1 627/11-,s <br />13. Are there any water wells on this parcel or adjacent properties? <br />14. <br />TYPE OF WELLS <br />Public Well <br />DISTANCE 70 TANKS(S) <br />ft. <br />Private Well <br />it. <br />Irrigation well <br />Monitoring Well <br />74 tt <br />Other <br />YES Flo I I <br />Will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ [ N0"I" <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 1.S M rK <br />Mailing Address Z W a© WL- �'� s ?" Sf/�✓ E E'fR, OK v 9 <br />Day Phone Number / o ro ' '64 9 O <br />7 <br />Signature Title Date <br />SHAW /lAi✓AK'AM/ <br />EH 23 046 (Revised 08/13/99) <br />Page 6 <br />L0 39Cd 800-U H1dId 660689060Z Z0:60 000Z/LI/50 <br />