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UNDERGROUND STORAGE TANK <br /> .--���/J GATE <br /> PH01lE ' -3 <br /> .+ODRESS V96q /1, <br /> OPERATOR S CITY <br /> OWNER R PHONE <br /> ADDRESS PHONE <br /> BILLING ADDRESS <br /> CONTACT PHONE <br /> ADDRESS 5 R <br /> APN LOT SIZE SHORT TERM APCD PERMIT <br /> WATER PURVEYORl0,5_ ANITARY DISTRICT �'- <br /> FACILITY TYPEc SEPTIC ES 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 # TANK # X <br /> TANK # <br /> STATE IO STATE IO <br /> STATE IO <br /> PRODUCT RODUCT �I' PRODUCT <br /> SIZE SIZE U 'Z� SIZE - - <br /> PIPING PIPING PIPINGMONITOR MONITOR MONITOR <br /> �d <br /> P tb r <br /> Vv <br />