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UNDERGROUND STORAGE T.MK <br /> Q"-RFILL PREVENTION EOUlebdE T INSPECTI jN REPORT FORM IPaae 1 of 11 <br /> IvoE-atAcf(no ❑1n2tdlaUon_Insaeclinu ❑�ierzei�Jnsnectian _ yg <br /> fAC1LITY INFORMAT'IUhi <br /> ij 44.i_Ji. �xb l..) i��4AVdM�!M�I <br /> r � i <br /> Su,=._-`N'. _ • .r,79ll:QottL7@usinrt<s'_ . <br /> @usl1ICSH"51e A�icjieast City — � <br /> UNDERGROUND STQRAQF TANK.,$ERVlciz TEQhNii;1AN iNr=t)RWN iJON <br /> �11 .., - .":4 YI'i'.. .fit 11J i11S1'l�.11. Vl . �• '. <br /> W7., <br /> Qverfill Prevanfinn ,prnrw �3iop Trgirtin9 rand Ggmf'c + — <br /> nP w_--'Pgo'-S+E __- <br /> Q10ERFll LLRREYF.ALTIONESIUIPMEiJTIN ��frTION INFORMATION. <br /> ' U Ltiv,tirm eJ <br /> Attach theinactlanFrasedut�ttrtd.aMdecmnentat(gn.lnau!>edtad4lsrminr�ter- a: <br /> By tank numbe_�,--_Stored <br /> IAlhat ix the'tank inaklw diameter?tt wiy 4 019 i <br /> 6.2-(I(.ui>Jinct satarandarily;;; t.ii:„ 1? — -- ❑Nu 0 Nc, ❑rL, ❑Ye:. ll!!'! <br /> is lho yeast nlnlnewecenAwrfty eent.Mwd7 - ❑M YA --�--Milt (]� ❑ ❑l� <br /> Qywlpjuven�aq j, t� elurertal 0Op W <br /> Q❑SSh�u� ,O�ApF�he,�w ❑Shuts Flew ❑Shute OR Flew El c-WO QN Flnw <br /> rwulenaa wh� m ❑Rwe'trida Flaw <br /> ❑Al1LAllunr ❑iVXAlauu ❑&VAlmw _ ❑AlYbinun _ <br /> Ate sew rae'6lelnrs intLJled m vent nldna� ❑YAA y ❑y i O X" --_." ❑1" ciao <br /> At whN lave'+In . ask r dfe everw <br /> Rambo (1 <br /> I g@t to acttuate7(Inch��</rom,�pjjq�j�jpj� 8a/ <br /> 1 _ et* he oar enl .e a jti of U'YY.{�llk.s��Ch <br /> D 0 <br /> CLYA <br /> �ffiseaF..oad_ a eubEtelo�e ❑�; <br /> 12&0 0 clag OlLi <br /> Mocha - -- .� i;-vet.iti in nv:•Ilon VL! I i Saecih In Lq.Tl n V.1 I!S city in sectim,V,l LIP i in section V.1 <br /> Q 11]SQeGIISHt R� .---,- Tm of Zi I Kim ❑,AQ I ❑. ❑_F,Q}I ❑z—; 31 QFdij <br /> alt Gama nvrkeri'Fall"rrarat 6a arnitialad al tlita saoAlon. Anv additianel eommanta may elao Ba A. <br /> L - <br /> OERTIFICATtON RY UST SERVICE TECHNICIAN.QQNQUCT►NG THIS tNSPEGWfi <br /> I harflbssartity that the overfill 2wilaUgo e9uygj £ja-rsQ4i�lttic�wi;h��lifvf4�i Coda frf��rpgylptiQp� <br /> _title 23,division 3.chanter 16.sectlon 2637.2 and all the information contained herein la <br /> ' 11ST_ Sanica Twcl+nlrlan Cn.:ahrre <br /> It We tacthly has more component*Open Uds form acconmtodeles,addidonal copies of this pays may be attached. <br /> C R5- -- mia nyirenrUntnl Roeorlino Syr.tem.ID=ldentihcation UST,=Updernround sterane tank.ICC o mle'rnatiensl Cede Ceuneil. <br /> AN=Audible and visa,21 <br /> RECEI 11 <br /> SEP 'ra8 2018 <br /> ENVIRONMENTAL HEALTH—: <br /> DEPARTMENT <br />