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• N <br /> AREA ,Q1?> NU'UNDERGROUND STORAGE TANK DATE ; <br /> DBA L.(,l.S.�.- {�(M uT/DOL-RA'11ax�s l'1' 7SP• LIIKt D PH01lE r. <br /> .� <br /> ADDRESS _(o49 fIti4-1221SMR[r Pu4tb . CITY <br /> OPERATOR (,,u <br /> PHONE �3- <br /> OWNER SMkwN 6 PHONE <br /> ADDRESS - ZOIC U(. SWfh►� IZh. a`.;". ,;: <br /> BILLING ADDRESS dbl6►tE As /f6GUF, - <br /> CONTACT J#-(,(,fiJ tt'E25fl� PHONE <br /> ADDRESS &J%_t y <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR Ck, jj&&2i2= _SANITARY DISTRICTS "• ' '<:' _ `' '� <br /> FACILITY TYPE <br /> /Y(ar Nrrt.�� �_SEPTIC WELL <br /> TYPE 1 2 3 4 5 TYPE 1 2 3 4 .5 TYPE 1 2 3 4 5 TYPE _1. 2.. 3 Al ; 5' <br /> TANK # <br /> lel TANK # DZ TANK i 03 TANK Q4 '+''A -:;3'• ; <br /> STATE ID O A -STATE IO STATE ID STATE ID <br /> PRODUCT _)f tiGt6c_ PRODUCT U Ot- PRODUCT PRODUCT/` O t z �{,• ; <br /> SIZE 10400b SIZE 10�001D SIZE (0!000 SIZE OD <br /> PIPING PIPING PIPING ,hr(G PIPING� �''. <br /> >.;. MONITORS MONITOR _ MONI70R MONITOR <br /> k. <br /> PiOiu& . (roe 4 <br /> u' <br /> , <br /> t <br /> Y <br /> / f� a3;� l..yyyCRR`� (t1 <br /> f.J • l 14�:: 3' 1. <br /> ej <br /> Y <br /> .'fix `r•�' �� r�� �j, 1 <br /> � Y <br /> 6/86 <br /> UST 24 <br /> ,: % <br />