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AREA ��j 2 UNDERGROUND STORAGE TANK DATE C� <br /> DBA S'�fmcl e" ,e/Z'l i�� '" PHONE ZO _ <br /> ADDRESS 16 5769 I�, ( �/ C _ CITY <br /> OPERATOR jGliyn� _ T PHONE <br /> pRoll.2OWNER i ' o/L/e_ 4 PHONE <br /> ADDRESS <br /> BILLING ADDRESS (it ooh , 0 _f?07( c <br /> CONTACT PHONE 4'-6�/"Y <br /> ADDRESS <br /> SIZE lrZ-2-A� SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY D/I�TRICT <br /> FACILITY TYPE ,� SEPTIC C/ WELL <br /> TYPE 12 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # TANK # TANK # TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT U A450f r n e PRODUCT PRODUCT PRODUCT � <br /> SIZE - 101PV SIZE SIZE SIZE <br /> PIPING PIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br /> 9-6 <br /> L5 <br /> foo <br /> 1-5 <br /> A(r J�, <br /> 3 <br /> UST 24 6/86 <br />