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AREA UNDERGROUND STORAGE TANK DATE <br /> DBA PHONE <br /> ADDRESS f(p L /NE CITY S7VCkrn ) <br /> OPERATOR PHONE <br /> OWNER ��,� PHONE <br /> ADDRESS <br /> BILLING ADDRESS P•D. /p STVC gtyx) <br /> CONTACT PHONE y(o/- yU 9 3 PX� 3 ya <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACJIIJY T_Y-PE SEPTIC �+►.E.LL ;34 <br /> TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1, 2 3 4 5' TYPE 1 25TANKS# O) TANK # �2 TANK # �0 3 �. ` TANK #STATE ��D . STATE/l STATE ID� STATE ID <br /> PRODUCT` SM PR-�UCT PRODUCE PRODUCT <br /> SIZE ZE ��, �Oy�, SIZE SIZE <br /> PIPI G IPING PIPI r,%' _ PIPING <br /> MONI ��f MO i$R ` MONITOR MONITO <br /> s <br /> f <br /> y <br /> i <br /> UST 24 6/86 i <br />