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AREA / UNDERGROUND STORAGE TANK DATE <br /> DBA _PH,QNE <br /> ADDRESS CITY _ <br /> OPERATOR PHONE <br /> OWNER PHONE <br /> ADDRESS <br /> BILLING ADDRESS <br /> CONTACT/Jby� AffIA nn10AG Iffil 71, (10i PNONE�f - 722- �f <br /> ADDRESS Lj� <br /> APN LOT SIZE SNORT TERM APCO 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 0 TANK 0 TANK A TANK <br /> STATE IO STATE ID STATE ID STATE ID <br /> PRODUCT RODUCT PRODUCT PRODUCT l <br /> SIZE /"� �/ SIZE SIZE SIZE <br /> PIPINGPIPING PIPING PIPING <br /> MONITOR MONITOR MONITOR MONITOR <br />