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AREA UNDERGROUND STORAGE TANK DATE oZ 7j 7 <br /> DBA a� PHONE _ <br /> ADDRESS 15 L S . i CITY �scaQrn� <br /> OPERATOR <br /> - PHONE <br /> OWNER , (A) -' A Gt PHONE <br /> ADDRESS Ip 5 cz5C <br /> BILLING ADDRESS <br /> CONTACT <br /> ADDRESS / <br /> APN aa - LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE � tUcct� SEPTIC �� WELL ti <br /> TYPE 1 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 #_ -I- <br /> TANK # TANK # <br /> STATE IO x}212,900 , STATE ID STATE ID STATE ID <br /> PRODUCTPG ,�y_� PRODUCT PRODUCT PRODUCT <br /> SIZE 5'S`� SIZE �IZE SIZE <br /> PIPING % s $�pIPING SIS PIPING PIPING <br /> MONITOR � MONITOR _ MONITOR MONITOR <br /> 12q J <br /> 30� <br /> a_ <br /> .o <br /> I ©WTD <br /> UST 24 6/86 <br />