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Liar «` _ <br /> UNDERGROUND ,STORAGE TANK` <br /> AREA 4 DATE <br /> DBA <br /> PHONE (•�O�l� lv�-/�rp <br /> ADDRESS AgLo �Q0 (y CITY L,S]�DC�7�'S�-t},•Li <br /> OPERATOR G PHONE (,?Oq) Y-lopaa, !L07 <br /> OWNER $ �J t PHONE <br /> ADDRESS / Yp S 4G1� C 4(p <br /> BILLING ADDRESS / I <br /> CONTACT �' .� PHONE�a707 <br /> ADDRESS <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR _CDs SANITARY DISTRICT G O S _ <br /> FACILITY TYPE -Ser��`G� �S-fa y�,�o-,,�r 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 # r TANK # 62 TANK I TANK <br /> STATE ID-5D 1 STATE ID IT6I t 9'5 STATE ID STATE ID <br /> PRODUCT �. PRODUCTsuLCL PRODUCT PRODUCT <br /> SIZE 14D SIZE 6-, 60 SIZE SIZE <br /> PIPING DpeSSoj-a, PIPING PIPING PIPING <br /> MONITOR ^ MONITOR MONITOR MONITOR <br /> J trj UcD a/it L <br /> I <br /> ys r &P -- <br /> Wes-tL#A)E <br /> EH 23 030 8/89 <br />