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. I <br /> 13. What is. the depth to groundwater? <br /> Describe the source of information: <br /> 1.:w e] w,aL �. T'v �jr�wi.►taw wFt' .�d�lt �r �:'i-i ori i <br /> I <br /> 13. Are there any water wells on this parcel or adjacent properties? N YES [ [ NO-tt- <br /> LTYPE'OF WELLS DISTANCE TOT S� <br /> Public Well ft <br /> Private Well ft. <br /> i <br /> Irrigation Well ft. <br /> Monitoring Well ft <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with aC2bo;�o�uqor underground storage tank(s)? YES -NO[ j <br /> 15. Indicate the responsible party to be biIIed for additional PH EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant, e.g. property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name 1-L bn...lor <br /> i rt27t <br /> Mailing Address t Srr S pxvv� Ate,A <br /> Day Pho Number �'_`t ) l.{3�[� g9 9 <br /> Sig tore Title Date <br /> I <br /> I <br /> i <br /> EH 23 046 (Revised 9/11/96) Page 6 <br />