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M <br /> UNDERGROUND STORAGE TANk-"' �� 2 <br /> AREA DATE <br /> PHONE <br /> DBA <br /> ADDRESS i a5_a m l.GL4 CITY D G <br /> PHONE 3 <br /> OPERATOR <br /> OWNER -elr �J.� PHONE <br /> ADDRESS <br /> BILLING ADDRESS <br /> PHONE <br /> CONTACT <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPEs4ct !Fi QSEPTIC WELL <br /> a <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 if—L— TANK # I D TANK if 1 / TANK # <br /> STATE ID STATE ID STATE ID STATE ID <br /> PRODUCT PRODUCT 1�2 OvO PRODUCT ROO PRODUCT <br /> v If <br /> SIZE / 0,000 SIZE d SIZE d SIZE <br /> PIPING �-Ow PIPING _ y`{7 lav PIPING ��7 U"" PIPING <br /> = <br /> MONITOR P MONITOR M L MONITOR ►1'L-�-' MONITOR <br /> EH 23 030 8/89 <br />