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AREA _ l UNDERGROUND STORAGE TANK DATE Z G <br /> DBA GI�CVrUY� �«`�ia� xf r1yUS� PHONE <br /> ADDRESS —CITY ,S' <br /> OPERATOR J on �elzm `1�P PHONE <br /> OWNER <br /> fon l/ 11 (1•„ L PHONE <br /> ADDRESS 5_,z_ ar&C !Y, <br /> i � >< SGW rah i _n _rA 9y�dS <br /> BILLING ADDRESS ��ar�/ ,f <br /> -- ,/ �.-jS-R11 �i^M n < �<<n 95/9 S- <br /> CONTACT _ JFK �1"�2 Si� PHONE <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR Cq_) 2�r se_ ANITARY DISTRICT i <br /> FACILITY TYPE ��� <br /> .�.rVl• S">ta •��„ SEPTIC h�iI- WELL / <br /> TYPE I (D 3 4 5 TYPE 10 3 4 5 TYPE 1 3 4 5 TYPE 1 3 4 5 <br /> TANK H�_ TANK Nom_ TANK N 3 TANK # <br /> STATE I D�2r�/DO STATE I D C�Sle SOD/ STATE I D _42S6 /DD 5/ STATE I D �— <br /> PRODUCT (°2t'6�Q02 <br /> PRODUCT R PRODUCT ��Q�, PRODUCT <br /> SIZE <br /> 05 SIZE <br /> SIZE <br /> PIPING Su.clNar� PIPING -.SLLc�idn PIPING / <br /> MONITOR ,,00 �l <br /> MONITOR PIPING/y�,?rn ��MONITOR , MONITOR <br /> O� <br /> �� OD <br /> UST 24 6/86 <br />