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♦ I <br /> AREA -�-f-- p UNDERGROUND STORAGE TANK DATE ADDA �✓yA C � PHONEso ell� <br /> ADDRESS y9�"1 [,{j� _CITY <br /> OPERATOR l 10 _PHONE <br /> OWNER S (A PHONE <br /> ADDRESS S kj <br /> BILLING ADDRESS <br /> CONTACT PHONE <br /> ADDRESS --9 A <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYOR L0.5. SANITARY DISTRICT <br /> FACILITY TYPE - SEPTIC LEES WELL <br /> TYPE 1 2 3 4 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 TYPE 1 2 3 4 5 <br /> TANK N�_ i_ TANK HTANK N TANK N <br /> STATE ID STATE ID4z' <br /> STATE ID STATE ID <br /> PRODUCT PRODUCT PRODUCT# 1 �C PRODUCT <br /> SIZE SIZE SIZE CZJZ-) SIZE <br /> PIPING PIPING PIPI PIPING•' <br /> MONITOR MONITOR 1TOR MONITOR <br /> rI S�RR�1 T3ooT1� I <br /> N -- <br /> �1 <br /> S� <br /> ugI <br /> IIST 94 6/86 , <br />