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I _ UNDERGROUND STORAGE TANK � DATE l <br /> PHONE5.3/-6 6 <br /> DRESS 3-? _CITY SA)G4 - <br /> PERATOR S714_ <br /> 7D PHONE 23 -G,Fb o <br /> OWNER S1a_ _ _ _ - -PHONE— <br /> ADDRESS <br /> HONEADDRESS L4 <br /> BILLING ADDRESS 5/4- <br /> CONTACT m . z: f _ • PHONE r4 <br /> ADDRESS ,- <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> MATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE SEPTIC WELL <br /> TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 12 3 4 5, <br /> TANK # K # ljy TANK # 03 TANK # <br /> STATE ID_ STATE [D STATE 10 STATE -ID <br /> PRODUCT ^� PRODUCT + . PRODUCT► PRODUCT <br /> 5 1 Z E l0 SIZE 3,000 SIZE S"Sf6 SIZE <br /> PIPING PIPING PIPING PIPING•' " <br /> MONI R MONITOR MONITOR MONITOR <br /> AJ <br /> LORJN SHANIEY <br /> AFAC cooPpNAToR <br /> INCOApORATM <br /> CID94 <br /> RD.. <br /> IlST -2n 6/Rf, <br />