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r / r <br /> fAREA L' :RGROUND STORAGE TANK DATEfBA / �. � -7q J rr <br /> in .-� 'PHONE _ l3 <br /> ADDRESS / CITY <br /> OPERATOR PHONE <br /> OWNER PHONE �— <br /> ADDRESS <br /> BILLING ADDRESS <br /> CONTACT �,/1PHONE <br /> ADDRESS <br /> API LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT c4,-b% <br /> FACILITY TYPE SEPTIC 0 J0,- <br /> WELL +� � <br /> TYPE 1 0 3 4 5 TYPE 1 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # TANK # 'mak TANK # TANK # <br /> STATE ID- STATE ID STATE ID STATE ID <br /> PRODUCT PRODUCT jLfi .tom PRODUCT PRODUCT <br /> SIZE 000 SIZE ��oCO SIZE SIZE <br /> PIPING �.l� PIPING PIPING PIPING <br /> MONITOR S MONITOR _ 7 _ MONITOR MONITOR <br /> x blsPt1Jsc� <br /> f ; <br /> UST 24 6/86 <br />