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` _ UNDERGROUND STORAGE TANK <br /> AREA DATE' <br /> DBA PHONE 9 - _:3_-_,;,- <br /> ADDRESS CITY <br /> OPERATOR PHONE <br /> OWNER �Y) �, c�_ GJc Ir, o PHONE <br /> ADDRESS /d p / &J C�r�Ci S�- i;'J�Jr -4i rlg-- 11J __gS33�� <br /> BILLING ADDRESS S"o-c- r,4 '9533 G. .. <br /> CONTACT �_ PHONE �Lrjq-a-3?, - y6.� <br /> ADDRESS /epd/ Tl22 ere r�a- <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 # I TANK # TANK # TANK # <br /> STATE ID STATE ID STATE ID STATE SD <br /> PRODUCT PRODUCT PRODUCT PRODUCT <br /> SIZE p $�ffl g _ SIZE -SIZE SIZE <br /> PIPING PIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br /> N .. <br /> vf�� <br /> EH 23 030 8/89 <br />