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r� 1� <br /> REIMBURSEMENT REQUEST - UNDERGROUND STORAGE TANK CLEANUP FUND <br /> CLAIM NO: 006570 REGION: 5 REIMBURSEMENT NO: <br /> CLAIMANT.- MCALLISTER TRUSTS <br /> CO-PA YEE.• NONE <br /> JOINT CLAIMANT.- NONE <br /> DONALD D CRA WFORD JR <br /> CLAIMANT ADDRESS: 580 CALIFORNIA ST#1800 <br /> SAN FRANCISCO, CA 94104 <br /> CONTAMINATED SITE. TRUCK TERMINAL <br /> ADDRESS: 601 VENTURA AVE S <br /> STOCKTON, CA 95207 <br /> LETTER OF COMMITMENT $125,000 AMENDMENT NO: O <br /> PROJECT COSTS INCURRED TO DATE APPROVEDFOR <br /> (This Section to be completed by claimant) PAYMENT(TO-DATE) <br /> (State Use Only) <br /> 4 1. CORRECTIVE ACTION COSTS <br /> (Costs entered here must be cumulative, <br /> Total-to-date, NOT INCREMENTAL.) <br />= 2. THIRD PARTY JUDGEMENT <br /> 3. ADJUSTMENT <br /> I <br /> 4. DEDUCTIBLE (Subtract) (5,000) (5.9QO.) <br /> TOTAL (Lines 1, Z 3 & 4) <br /> CERTIFICATION. <br /> I have read and agree with the "Conditions of Payments"(Exhibit I) listed on the reverse side of this document. <br /> NOTE: This request CANNOT BE PROCESSED unless the "Condi ons of Payments"are included on the reverse side <br /> when submitted. <br /> The costs claimed have been incurred and have been paid or will be paid within thirty (30) days of receipt of the funds <br /> requested hereby. If such costs have not been paid within 30 days,funds received under this request will be returned to the <br /> State Water Resources Control Board. <br /> CLAIMANT SIGNA TORE: DA TE: <br /> STATE USE ONLY. APPROVAL FOR PAYMENTS <br /> $ LESS: $ _ $ <br /> Approved for Payment to Date Previous Paymentv Amount Due <br /> Reviewed By: Title: Date: <br /> Approved 13v: Title: Date: <br />