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i <br /> ' Y <br /> REA UNDERGROUND STORAGE TANK DATE <br /> /ADDRESS <br /> BA a r o LeX PHO(lE I -ate <br /> f 3�- CITYcJ.PERATORre� PHONEWNIE R 2_Z -- OG 9 7 PHONE_f3 I - y <br /> I ` ADDRESS a7F 9Q + C_ cj <br /> BILLING ADDRESS 3 a�e.+- a 4� c lc <br /> CONTACT Ll PHONE <br /> ADDRESS �-f a <br /> APN /o/-loo&-c/LOT SIZE SHO TERM APCD PERMIT <br /> WATER PURVEYOR SANITARY DISTRICT <br /> FACILITY TYPE �e 01( Icf- �S4a4-t.O-'SEPTIC WELL (� <br /> TYPE 1 (D 3 4 5 TYPE 1,D 3 4 5 TYPE 1 2 3 4 5 TYPE 1 --2-3 5 <br /> TANK # TANK # TANK # 3 TANK # <br /> STATE STATE ' STATE ID SY ,, STATE ID <br /> PP.ODUCT PRODUCT ?RnOUCT PRODUCT - <br /> SIZE p SIZE 2hD SIZE SIZE <br /> PIPING u PIPING 5 PIPING PIPING G _ <br /> ti!CNITOR S MONITOR ONITOR 12WIr. MONITORY <br /> t <br /> osed P". ?1y <br /> M <br /> Q� . !�'t <br /> s ate., /°°o�� re <br /> L <br /> UST 24 6/86 <br />