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AREA n UNDERGROUND STORAGE TANK DATE <br /> DBA 1 pw6;,u - loc. PHONE 4IDb--+O+l <br /> ADDRESS 4-0 ( t4. STcQ,/tb CITY TYQ3 <br /> OPERATOR PHONE <br /> PHONE <br /> OWNER CAmG PHONE <br /> ADDRESS <br /> BILLING ADDRESS <br /> CONTACT W.L4 . CoLj-,C-qZc- - J�c��(! �o(�irn�a PHONE ( b--46 ( 1 <br /> ADDRESS -101 ' ) S'[OCA,_) J <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE 60AT )kj&tKS SEPTIC WELL <br /> TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # B I TANK # OZ TA # D NK # 04 <br /> STATE ID STATE ID TATE ID STATE ID <br /> PRODUCT PRODUCT PRODUCT PRODUCT <br /> SIZE D07D SIZE $4"-DSIZE SIZE <br /> PIPIN PIPING - PIPING PIPI <br /> 7OR MONITOR MONITOR MO TOR <br /> ;7 � s/22 7 <br /> UST 24 6/86 <br />