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`,<EA UNDERGROUND STORAGE TA <br /> /OBA . p , -;q 6� NK DATE <br /> ADDRESS p PHO�J } <br /> OPERATOR /� CITY <br /> nWNER PHONE <br /> !! ADDRESS �1, 1 .oy[ y V& 6, PHONE <br /> S n�. <br /> + $1 LL ING AOURESS , <br /> CONTACT <br /> Or <br /> ADDRESS PHONE <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> ' WATER PURVEYOR --- <br /> SANITARY DISTRICT a� <br /> FACILITY TYPE r SEPTICELL <br /> TYPE 1. pP 3 4 5 TYPE 1 '2 3 4 5 TYPE 1 2 3 41 2 3 4 55 TYPE 1 2 3 4 5 <br /> TANK # / TANK # TANK # TANK # <br /> STATE ID 7 S-aOJ STATE ID STATE ID STATE —ID-- <br /> PRODUCT/tuJAaz j4 PRODUCT PRODUCT PRODUCT <br /> SIZE vnv�� SIZE SIZE SIZE <br /> PIPING .. � PIPING PIPING <br /> PIPING <br /> MONITO � MONITOR MONITOR MONITOR <br /> nFFl C.,d <br /> Q'recc, W kxP-i evasfe o r <br /> ru rra- s <br /> r <br /> UST 24 6/86 <br />