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AREA UNDERGROUND aTORAGE TANK DATE <br /> DBA PHONE �j t <br /> ADDRESS CITY <br /> OPERATOR PHONE <br /> OWNER ,e•. PHONE <br /> ADDRESS 4 <br /> BILLING ADDRESSJWaT 2f ' <br /> CONTACT _ (��,( %j�° - PHONE <br /> ADDRESS ., <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR „'�., SANITARY DISTRICTr' <br /> FACILITY TYPE f�ktta SEPTIC eel/t4 WELL <br /> TYPE 1 3 4 5 TYP 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # ANK # TANK # TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT `?, PRODUCT PRODUCT PRODUCT <br /> SIZE .- SIZE SIZE SIZE <br /> PIPING PIPING PIPING PIPING <br /> MONITOR 'J��' MONITOR MONITOR MONITOR <br /> 3/r. <br /> INT 24 6/86 <br />