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// OPERATOR <br /> REA �$ UNDERGROUND STORAGE TANK v DATE -3O—g[� <br /> BA N C `, PHONE y6Lk%01gDDRES s e,�— CITY , Qr �sn of��r PHONE yOt 1038 <br /> OWNER E6� PHONE �$1 <br /> ADDRESS Qft °1Lj5& m'fie. <br /> BILLING ADDRESS _ c5145" 9�kSll <br /> CONTACT PHONE t{k5-Wl S6Gb <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR � _ _ SANITARY DISTRICT <br /> FACILITY TYPE SEPTIC WELL <br /> TYPE 1 3 4 5 TYPE 1©3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # ifa• TANK #a TANK # TANK # <br /> STATE ID �?PV J STATE ID STATE ID STATE ID <br /> PRODUCT- ' PRODUCT v+.,¢afe f • PRODUCT PRODUCT <br /> SIZE 10 SIZELAS -S I-ZE _. SIZE <br /> PIPING ( _ PIPINGS, PIPING PIPING <br /> MONITORS 'r MONITOR 5� MONITOR MONITOR <br /> f <br /> e <br /> U'S f 24 (;!86 <br />