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REIMBURSEMENT RE VEST• UNDERGROUJVD STORAGE TANK CLEANUP FUND <br /> CLAIM NO' 01250 REGION. 5 REIMSURSFMENT NO: t <br /> CLAIMANT.• InI nd Paint Company <br /> CO-PAYEE: Non <br /> JOINT CLAIMANT' N o n <br /> 3 <br /> CLAIMANT ADDRESS: <br /> Stcr kLuri, CA 95204 <br /> CONTAMINATED SITE: Inland Paint Company <br /> ADDRESS: ' 117 West Harding Way <br /> Sto kton, CA 95204 <br /> LETTER OF COMMITMENT.' $ AMENDUENT NO; !� � <br /> PROJECT COM INCURR TO DATE <br /> (This Saaton to be compieted by damm. °' PhlF•A"I`(�f'471ir1 TE), <br /> I. COARECTWEAC770N COSTS <br /> (Costs entered here RUWt be cumuwve, <br /> Tad-to-data NOT INOMUENTA L) <br /> 2. THIRD PARTY JUDGEMENT ,� (:� ~�: s' <br /> 3. rlDJUSTM$NT <br /> 4. DEDUCTIBLE(Sub&acf) $ S 000 <br /> Torat s a,yLo. f <br /> CERTIMClTION. <br /> I have need and agree with the "Condif,ow of P4ynw='(2DWhit Q,(hied an the reverse,side of this doeunWRL ; <br /> NOTE. This request CANNOT.BE F unless the "CoisdAlions of payments"are included on the reverse side when <br /> ..r6,ni[�ct <br /> The craa cta med have been Incurred A Fwd have been paid or will dt paid within rhirry(30) days of receipt of the funds <br /> ,egwested hereby. If such coals have ni t been paid witkLv 30 days,funds received under this request will be reiurr ed to the <br /> Stere Water Resources Control Board <br /> CLAIMANT SIGNATURE: DATE: <br /> �oedfary» rtDa w i �Freot,+Paymar�i h ' <br /> DttC <br /> - .:.�#-XLAffi <br /> ' 'wrwr.l.�•f <br /> i1 1 <br /> Reinte�sri�� 4 i { h Y <br /> fi •�1FF�f � 3 ;��}` r <br /> x' x <br /> { Z i <br />