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Y <br /> r COMPUTER <br /> DBA 5 <br /> PREMISE ADDRESS: <br /> BILLING NAME: <br /> BILLING ADDRESS: <br /> FEE INFORMATION: <br /> DATE AMOUNT PAID SURCHARGE FEE MISC, / DESCRIPTION <br /> I r-,, V 5 C— ^ `t SAb <br /> ck �7 <br /> a 3 5 C-1 $ $ / I -T ++ i -19 �5 <br /> TANK INFORMATION: <br /> TANK # I STATE ID# / STATUS 5 <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 /> i <br /> FACILITY PERMIT APPRO• SURCHAO FEE RELEASED <br />