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AREA --, I UNDERGROUND STORAGE TANK I DATE <br /> DBA PHONE <br /> ADDRESS /J</' CITYtQ <br /> S( «/� <br /> OPERATOR PHONE <br /> OWNER PHONE <br /> ADDRESS <br /> BILLING ADDRESS �D�D , SN�• Com. 953�� <br /> CONTACT PHONE <br /> ADDRESS_ <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE 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 4 5 <br /> TANK # ( .. TANK # DZ TANK # O 3 TANK # <br /> STATE STATE I D (—�003 STATE ID 2641 SDI STATE ID <br /> PRODUCT PRODUCT PRODUCT Nl� PRODUCT <br /> SIZE �1�� SIZE ,5-b SIZE 10��60 SIZE <br /> PIPING PIPING PIPING ,1 PIPING <br /> MONITOR ;U , MOPIITOR MONITORb� MONITOR � <br /> � r <br /> f <br /> n <br /> Fi-ii <br /> ., <br /> UST 24 6/86 ' <br />