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COMPUTER # <br /> DBA <br /> PREMISE ADDRESS: \ R Q,c� <br /> BILLING NAME: <br /> BILLING ADDRESS: <br /> FEE INFORMATION: �5c-, S s R k,-a.) <br /> �jC�.cJU <br /> DATE AMOUNT PAID SURCHARGE FEE MISC, / DESCRIPTION <br /> }( $ O to $ > $ / A IF-)Q 7 <br /> ao)� <br /> TANK INFORMATION: <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> TANK # STATE ID# / STATUS <br /> FACILITY PERMIT APPROVt� SURCHAR,,, FEE RELEASED f �S <br /> t <br />