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t'ROv�a`j3�g <br /> /S"7,—Soo -zr-9 <br /> AREA _ /9 UNDERGROUND STORAGE TANK DATE -30 -g 7 <br /> DBA 6 / � (2) i`��(K A c PHONE <br /> ADDRESS CITY <br /> OPERATOR PHONE <br /> OWNER PHONE <br /> ADDRESS 7 1� 4 Gt �' _ EL�7 �. cl r2 5— <br /> BILLING ADDRESS �r7 �, D.L e_ aAkQ Ate, <br /> CONTACT PHONE'r ps �u al!y�� <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER 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 1 2 3 4 5 <br /> TANK #1 TANK # TANK # TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT �a s PRODUCT PRODUCT PRODUCT <br /> SIZE _T SIZE SIZE SIZE <br /> PIPING ;J PIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br /> 1 e k. <br /> i <br /> �u <br /> UST 24 6/86 <br />