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AREA UNDERGROUND STORAGE TANK DATE_-. <br /> DBA PHONE <br /> ADDRESS C I Ty <br /> OPERATOR PHONE 516V .5,'Z(?5r <br /> OWNER <br /> PHONE <br /> A <br /> --ADDRESS <br /> BILLING ADDRESS <br /> PHONE <br /> CONTACT Ztu& J <br /> �`ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT 7,z�7& <br /> FACILITY TYPE SEPTIC WELL A-11111 <br /> TYPEJ 2 3 4 5 TYPE_L•~2 3 4 5 TYPE 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # I TANK # TANKI 3 TANK # <br /> STATE I oo i STATE 10 /(-.�P'cfSTATE ID <br /> STATE ID I(-. t-- -, t- - <br /> PRODUCT PRODUCTb_,-,, PRODUCT PRODUCT <br /> SIZE SIZE SIZE 0A, SIZE- 5Lx+x <br /> PIPING PIPING <br /> PIPING P-A <br /> PIPING <br /> MONITOR MONITOR <br /> MONITOR MONITOR <br /> 0 <br /> 61 <br /> kgq <br /> -rafij k5 <br /> Do Atpb �9K <br /> LIST 24 6/86 <br />