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�sT <br /> ~ .v'DERGROliND STORAGE TaNX 16 <br /> �] <br /> DATE <br /> 0?31 <br /> D:A DZCG IOglq( <br /> ck) 95ZZ�o <br /> CITY <br /> ADDRESS 5 �3b <br /> PHONE <br /> OPERATOR la PHONE 5/0—Z S ZD <br /> OWNER I/l) 4 lle- <br /> L/ �V� 53U <br /> ADDRESS ?0 • OX b E <br /> C f �o <br /> BILLING ADDRESS PHONE �— <br /> CONTACT <br /> ADDRESS SHORT TERM APCD PERMIT�_ <br /> APN �_ LOT SIZE <br /> SANITARY DISTRICT C05 <br /> WATER PURVEYOR C S WELL <br /> SEPTIC <br /> FACILITY TYPE <br /> TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 3 TANK <br /> TYPE 1 2 3 4 5 i#__�- <br /> TYPE 1 2 3 4 5 2 TANK '��— <br /> �— TANK -- STATE ID <br /> TANK <br /> fePfJ ' STATE ID <br /> STATE ID STATE ID 'IQ_ ," �- PRODUCT <br /> PRODUCT <br /> PRODUCT �-j �_ PRODUCT SIZE <br /> slzE IoK SIZE i - <br /> SIZE l�o� PIPING rIP�� PIPING <br /> prpING S vr PIPING Ye rr� MONITOR <br /> MONITOR _ <br /> MONITOR'Tt OY51- MONITOR' <br /> i <br /> IV <br /> 3 <br /> EH 23 030 8/89 <br /> UST 24 6/86 <br />