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UNDERGROUND STORAGE TANK DATE <br /> +" r PHONE - 3�D <br /> RESS 5(0 Ll CITY Ey, s$ <br /> RATOR PHONE <br /> NER k is PHONE <br /> ADDRESS A- <br /> ILLING ADDRESS 5L <br /> S2 <br /> CONTACT I't 6 PHONE �- <br /> ADDRESS - Do <br /> SHORT <br /> � d►���► . �3t� <br /> APN LOT SIZE SHORT TERM 0 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 ,CNK # _ TANK # TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT V <br /> LaA tjXu PRODUCT PRODUCT PRODUCT <br /> SIZE SIZE SIZE SIZE <br /> PIPING � Q-►.1 PIPING PIPING PIPING v <br /> MONITOR 4F MONITOR MONITOR MONITOR <br /> `� <br /> e,n s 4 <br /> vv <br /> .t,/ <br /> , <br /> I i <br /> c � <br /> UST 24 6/86 <br />