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0 • <br />12. What is the depth to groundwater?%d X t n7 c: <br />-7o �d <br />Describe the source of information <br />1Mte6t?n— S. <br />13. Are there any water wells on this parcel or adjacent properties? YES [ I NOY <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />FOther <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YEVNO[ 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 />Sig <br />Name <�7 M C_C) <br />Mailing Address l 2 �` 5 S �► �� � S 3 S <br />Day Phone Number ( <br />Date <br />EH 23 046 (Revised 10/19/98) Page 6 <br />