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UNDERGROUND STORAGE TANK DATE <br /> PHONE rr <br /> uORESS5 CITY <br /> OPERATOR ~,CZ fi PHONE <br /> OWNER r : , ,-t_. PHONE <br /> ADDRESS <br /> BILLING ADDRESS f"0 rS9N M0 5T6c,k ea- 9 <br /> CONTACT C ( �1_a.:, PHONE <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR ;_ : , `mom SANITARY DISTRICT > <br /> FACILITY TYPE SEPTIC WEL <br /> TYPE 1 2 �3 4 5� TYPE 1 2 3 4 5 TYPE 2 3 4 5 YPE 1 '2', 3 4 5 <br /> TANK # ! / TANK #_ TM <br /> # TANK # <br /> STATE ID 7— STATE ID ��'�. STATE ID <!. 2G" STATE ID <br /> ` PRODUCT k, . PRODUCT � a PRODUCT (4L�ieo , r rc PRODUCT t,: fl <br /> ' SIZE ._' SIZE tie SIZE �1- d� SIZE 0 <br /> PIPING - . PIPINGPIPINGj 4.1s a.t. PIPING <br /> MONITO MONITOR * MONITOR -Aq�' MONI R <br /> oaa rf� E;( { 2000 RfC �,o ` <br /> 1 � f <br /> 24 6/66 �'. <br />