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'-3NDERGROUND STORAGE TANK °-- ;- DATE <br /> PHO14E <br /> ` CITY <br /> G <br /> i' PHONE kaO <br /> PHONE <br /> ADDRESS <br /> avlILLING ADDRESS /6p �j. ` �� 2'a b <br /> CONTACT - - - i i� v M E <br /> _ -. <br /> ADDRESS / `� �'>T., Sfl Clsar/Qs.z. jai •� vt',c <br /> Af <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR C1,t1 -� •SANITARY DISTRICT co cj <br /> FACILITY TYPE yLII/I¢7'�. SEPTIC r"-- WELL <br /> TYPE 1 -0 3 4 5 TYPE l op 4#i5 T PE 1 2U ��4� � } TYPE 1 2 3 4 5 <br /> T K # (O TANK # ppb-/!�. ANK # - TANK # (O3� <br /> STA IDSTATE ID ,# STATE ID r-' STATE ID <br /> RODUCT RODUCT PRODUCT PRODUCT /FSS+; <br /> S E SIZE L . SIZE O SIZE ► S <br /> PIPI G IPING L PIPING PIPING <br /> MONITOR # MONITOR MONITOR MONITOR <br /> 077 <br /> I <br /> I fl4 <br /> IrAIK x-113 <br /> Q t=lt4(t�t6 io <br /> )fo,c�a(� <br /> Abe <br /> r 6/86 . <br />