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4 <br /> EA �/g UNDERGROUND STORAGE TANK DATE <br /> DBA G^^s PHOUE <br /> (ADDRESS 3a E ter,, L„J CITY <br /> OPERATOR PHONE <br /> coq 33,1---/005 <br /> OWNER SLIA �q�— 3 3 4(' �3�g PHONE <br /> ADDRESS CI P, r <br /> BILLING ADDRESS.5Z <br /> CONTACT s�A PHONE <br /> ADDRESS SIS' <br /> APN LOT SIZE Z SHORT TERM APCD PERMIT <br /> WATER PURVEYOR �, ,U_L. SANITARY DISTRICT <br /> FACILITY TYPE (,�,� �„� SEPTIC PA;A4:e,, WELL ti/-46 <br /> TYPE 1 2 3 4 5 TYPE 1 213 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # Q/ TANK # pZ TANK # O3 TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT PRODUCT 7 PRODUCT PRODUCT <br /> SIZE SIZE I Z,Oo0 SIZE SIZE <br /> PIPING PIPING PIPING PIPING <br /> MONITOR MONITOR MONIT �k'fc G+ea� MONITOR <br /> �. �t3't�r�i•('�i:��2 l��novtal ttftb�� <br /> l <br /> S ' <br /> Lr� 2"ow <br /> Al I � <br /> r <br /> ' - s <br /> h+: - ic`3ti@:•�. s''�. '`�' h .+,..,iiw .,,ly .. .��Yy, 4�s'.�;A•�J t:,:�. ��P'� .,.:��s tt1 <br />