|
11/23/93 09:29 UST CLEANUP FUND -+ 912094640138 N0.590 P03
<br /> ROMBURSEMENr RE&�-ST - MWERGROUND S7"ORAuc TANKGLEANUP FUND
<br /> CI,AIMNO. 3242 REGION. S RF".8U,RSE,ME, rNO. 2
<br /> CLAIMANT: M.SANCFIEZ
<br /> CO-PAYER ' Noaa
<br /> C.Z IMANTADDRESS: 920S0.,DAV7DAVF-
<br /> STOCN7ON,, CA 95205
<br /> CONTAMINATED SITS': PACIFICCTAS
<br /> ADDRESS: 2088M4RIPOSA ROAD
<br /> STOCKTON,CA
<br /> R 01FCOMMHMEIVTAMOUNT: $30,000 AMENDMENT:0
<br /> PROJECT COSTS INCURRED TO DATE ;�larza
<br /> (77uis section to be completed by claimant) a
<br /> 11 CORRECTIVEACTMONCOSTS S
<br /> Y.y .....;:a,;....
<br /> (Corn catered hcrc must be cumulative,
<br /> total-to-d:te XUTINCREMENTAi-
<br /> Seo�teimburaeataat Rz,quart tartruetiaas)
<br /> 2. 7WI?D PARTYJU DGMENT A«M6 ~:::� sr';.�M•: �::u:
<br /> �'KwIx11,,.Ji:ViP> :lwJR::x:
<br /> 3. DEDUC'T'IBLE (Subtrnet)
<br /> TOTAL
<br /> CRR7TFIC4770N:
<br /> Xhavereadand agree with the "CunditioasofPayment"(Farhibitl),listed an the -cvc:r$cS do of this document.
<br /> M. This request CANNOTBF PROCESSED unless the "CQaditiaas alPaymeut"ara included otr-ihe
<br /> verse-aide wheII submirtud
<br /> The costs claimed ha ve been incurred and have been paid or OW be paid within tbirty(30)d--'Ys
<br /> of reeeiptQf rite,funds requested hereby Tfsuch rests have aot bct n paid within 30 d 3M funds received
<br /> under thzs request will be rerzaved ro the Stare Water Resources Control Board.
<br /> CLAIMANT SIGNATURE_ DATE.
<br /> n<.
<br /> w' t.EVE""„'.:... •" r:«;;;:::gym:="; :�<�:s°"1Oovo .<.,P, .'" r�•a�w.,:?'."`..�"•M,
<br /> taf'ctuIy waexytrt�sirxP>e «JG € ��>
<br /> gGpwn.;w>ntw.vy � ;:w,wJiY.�diSsZGPI:%Mf,�W.�•E::N>yN .�x�KD>+xe>grin>%[.:: :w'PPY.xr,.NWa�L:v.:<n.pTir�M;�:;�:. ;�ro�:M t±:�in« :«'�- :':6H%.%J•Ox+,::1W,e<.w,VMrS.x,
<br /> M:u"P>.>' •M '.xaw �sern.Ma•.. v:'Pi�',:��i.. »:..,�:�T�°Gm ..S..v, +wPio.>wm�.,,,.%:>�.x��vowM
<br /> .e.ti...w w;.M...:..'r...:w:iH:.:.r• .::::W�nftal:ra:ror vsn'"•: ne i�:��i':,wi.i
<br /> ---. ...�w. ,.•xxve:»:[.»ao.Jo:,•ne.�exnr ^"a':'
<br /> ^'N ,�,�(�...«row.•:«.: w>w
<br /> -w•N>M:�µ..� �nM.•.�x nv:iiw e' •isN.�.:.v.,,:s�,.c.h.:.1vn.Y.x:.>xw:,.u'...v<, >'WiN:,.
<br /> e�eq�w':'pyi�:i�i<Td:M�.+GN m"�.� upmi�:.T; .000�h.:a.xw,a.,:• ,�,., w�oa s�rw .q;�;
<br /> ea+.+, w.yv.,Yw.++PV.n•.SwniP' ".'>:�"ef-�.., vcyiry
<br /> M:•ry M>ie`!>' l,Jy»f.q.v. �:e�t�, ,OFxeeew.
<br /> ?":x'\PK• •K Ktk:.JP/<i:✓i:'..MTs�JI .}��.!0•,.Vit ,lli:e.,:::i�:ij H,. .%:
<br /> p�x� MN y�ni.;::r.:>....M+f:N.v.. ..>.•.a...x<..n. ha>w..,
<br /> w.'e:+:•.:�I• wq.x%W.:i��we xti vxOVC�P': 1tTy^' w•x,gn..t..:.�.ex.:..., „>OO,;x'
<br /> ,Vnv>, Gn ,•x..n:ar.v:• x.M,.:.P, awn.,:..n::.xe>ey::.aww..:.r.,;.
<br /> •.JaJY. ,wMx.Y:M.r wax.x.wtx• to>x.>:µ•: .'Vn'oI»[::x.x.:.c<'..>xa.w:n.:.>.nr.an: ^'nv re:�i.v
<br /> .,wr^.rG.m.w:.rx+. .:h>v.,G.n.;..n e:: '.:.�:.x...:..n:•.:,[.:....w,:t.x+:. anFv..
<br /> +i,.J:.. yyGnt.V.xrnrt'Iv.+:o>x.5•e�.rxJS^:.n::i+.<.v.Jr.:.,>.T.v.x:v.vn::.:>,...P:. v.>:n.n..1w....,nn..w..:......-•..e.•:.........�a...,xv>
<br /> �1W;w.GP Jw
<br /> 1y:vt
<br /> >.a
<br /> n.:xLI1P>P:P:
<br /> M Qn
<br /> :.k
<br /> x•>1x
<br /> �] R
<br /> •-�,A,ii.�w�• 'x•':vA»>m•xel•x•R•tw.::••
<br /> I{BV16(yam C7 »W x
<br /> V
<br /> >.,re
<br /> .V`�
<br /> e: n
<br /> wit.•.
<br /> xv.y1V>
<br /> t...VN...>,.:�,..v:�K... • ,.. N....n...,..Nx »:�40w....v u.uv,Nn.•...:. .,v
<br /> ..n...n V. , ..nn...:.M:.n,.r,..n.w.1M.Rmv:•Vr.,..v.vw,..w.n:::..:..:..:..
<br /> ....:..:..:.wM•..n.r..... ..... X.
<br /> .........v>.V...NP>•M>nvv>%•nµ,nw:t•n:�.Mn.-.:......>m..:....:.n.... .��'
<br /> Z ie
<br /> :.,:.:.en:..:....w.�..,,..,...:.:,..n.....a......... :.n.... a.:�.<.;::;;a�M:c:.
<br /> Force U57C'F'—REQ (Rev.0.1)
<br />
|