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UNDERGROUND STORAGE TANK <br /> AREA DATE <br /> PHONE <br /> DBA <br /> CITY <br /> ADDRESS 50.3 PHONE �f y <br /> OPERATOR <br /> OWNER PHONE <br /> ADDRESS N �� <br /> BILLING ADDRESS <br /> � PHONE <br /> CONTACT <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE <br /> SEPTIC WELL <br /> TYPE 1 2 3 4 5 TYPE 1 213 4 5 TYPE 1 2 3 4 5 TYPE TANK #1 2 3 4 5 <br /> TANK # / TANK # TANK # <br /> STATE ID STATE ID <br /> STATE ID STATE ID <br /> PRODUCT ,J-5� PRODUCT '� <br /> PRODUCT PRODUCT <br /> SIZE uu� <br /> SIZE `2 SIZE SIZE <br /> PIPING PIPING PIPING <br /> PIPING MONITOR <br /> MONIJ�� -_ MONITOR MONITOR <br /> EH 23 030 8/89 <br />