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PHONE <br />LOT SIZE APCD PERMIT <br />WATER PURVEYOR <br />FACILITY TYPE <br /> SHORT TERM <br /> SANITARY DISTRICT <br />SEPTIC <br />5 TYPE 1 2 3 /4 5 <br />5-2= ANK <br />STATE ID ID <br />RO DUCT <br />TYPE 1 2 3 <br />TANK # <br />STATE ID /- 4,40 <br />PRODUCT <br />ZE <br />PIPING <br />MONT OR <br />SIZE <br />PIPING <br />MON I TO MON I IR <br />BILLING ADDRESS <br />CONTACT <br />ADDRESS <br />APN <br />TYPE 1 2 3 4 5 \ <br />TANK # (3--/) <br />STATE <br />PRODUCT <br />SIZE /0 <br />PIPING <br />MONITO <br /> WELL <br />TYPE 1 2 3 4--\ <br />NK # <br />STATE ID <br />PRODUCT <br />SIZE <br />PIPING <br />spto i)f) 12-64-to cls0 12.6)-tou61) <br />cs. 1( <br />//- 7 - ?C, ere% / 7‘-xe 71/71 <br />k),,.-)7Alt)t< t.)---2"9- LA), <br />fe.A514 6 tie") <br />AREA UNDERGROUND STORAGE TANK-- -- <br />-Ct) .11); a_ Fr,we Cdovoyide r Alc i< <br />ADDRESS ..-.?c71 /1 4i , <br />OPERATOR ' <br />OWNER <br />DATE /O/7 / <br />yHONE --7466,-6r <br />CITY S7/0 <br />n"n"r)774A:ki 0 rnuric c/7 <br />PHONE <br />ADDRESS <br />, 1 50,1LthLtp_ <br />• <br />UST 24 6/86