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COMPUTER # <br /> DBA <br /> PREMISE ADDRESS: C) (,:D <br /> BILLING NAME: <br /> BILLING ADDRESS: <br /> FEE INFORMATION: <br /> DATE AMOUNT PAID SURCHARGE FEF MISC. DESCRIPTION <br /> -\b- 1 $ 3\ lo.uv <br /> -71%1 .r v cNl.CX 61AAA <br /> $ <br /> — 3 <br /> 1 -90 <br /> - --\ 0 C�lC\0 <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 APPROVED SURCHARGF FFF RFIFASFD(1) 4/�1 <br />