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i <br /> COMPUTER N C) 3 <br /> DBA Q X�. <br /> PREMISE ADDRESS: ` � c 1 ✓ P <br /> BILLING NAME: <br /> BILLING ADDRESS: <br /> FEE INFORMATION: <br /> DATE AMOUNT PAID y SURCHARGE FEE MISC, / DESCRIPTION <br /> p-.Q')- $ Soco $ S $ / I A Tan1-1, 4b,�2,9�8g <br /> a-CA $ 1 -�sn $ $ / IA - V9ku <br /> a _9 $ Inc) $ $ <br /> TANK INFORMATION: <br /> TANK N I STATE IDN / STATUS SC - / ti <br /> TANK N STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> TANK d STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> TANK N STATE IDN / STATUS <br /> FACILITY PERMIT APPROVEt SURCHARGE FEE RELEASEP �1/ 1 <br />