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AREA 76RGROUND STORAGE TANK �` DATE <br /> _,DBA iG+-U r PHONE _2 _ <br /> ADDRESS j CITY <br /> OPERATOR �lk PHONE <br /> OWNER 'R 01-ion �e�Gte! y� PHONE_ � (�- (� 7� <br /> ADDRESS f l .� 1 t/G'. CA q6LI <br /> BILLING ADDRESS kS a o 5 <br /> CONTACT �J bm �'j11 S PHONE Ct�C- j'Z <br /> ADDRESS S I Fl- <br /> APN - T SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR WdJ � o Mcepwj SANITARY DISTRICT <br /> FACILITY TYPE SEPTIC WELLTYPE 2)1 ) 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK # , TANK # TANK # TANK # <br /> STATE IO S3 p ESTATE IQ STATE ID STATE ID <br /> PRODUCT PRODUCT PRODUCT PRODUCT <br /> SIZE _ p SIZE SIZE SIZE <br /> PIPING gU C,-h'oh PIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br /> rT <br /> n <br /> N <br /> p-..,ds rase <br /> r <br /> UST 21 /t;� <br />