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1 <br />~~C`~~_rv D~~~'i'1~~~ I` ~F ~~^V'I~~ .r~~'~'~~ Q~.T <br />'!i~~R~RO+CT_~~3 ST(~RA.GE T~~ PI~a~A`i~r ~- <br />?ERI~'~~~' ~ ~.'P~~C~'~'IOi~ - <br />TA.N~~ O~%~~R <br />Pl~~.tSE' PRlM ClEtRLY <br />N~aME _.._ .:~. <br />A.DDR~SS <br />PERMZ'~ FEE ASSESSI _ <br />19$S - I993 ~25 pe~ year for e~ch tank <br />^~al~ r~ ~25~ u=~ x w y~s -- ~ 5 <br />ADDR~SS ' - <br />x • <br />r.~xx ow~v~ src,wrur~ <br />DATa <br />PHONb <br />PRC?~~tT"Y OWiYEIt <br />PIF1Sa PRrM Cx1~.1RLY <br />~r~_ Marion. County - <br />~A~S$ 100 H igh; ;St NE <br />Salem OR 97301 . <br />?~ <br />. PROPFRIY O VaZi/RF <br />~E~tIY.I~'~E~ <br />P:~s~ p~xr ct~.vttr <br />1~ Marion County <br />ADDRESS 10 0 H i g h S t N E <br />Salem OR 97301 <br />X <br />~fXM~17~ S1GN.~7~t7R~~--..~._ <br />1994 - c~rren~ year ~ ~35. pe; y~ar for. ~c:~ rank <br />_. ta.iiks C~? Sa5 <br />AIvSpL7y'Z' g~TFD ~265.00 <br />Owaers of e' t firat timc, nead co <br />submit ~exs for a , through the currea~ year. <br />~'AC~I~TY <br />' p~ pR~ oFwar - <br />N,~.~ Former Chevron Station <br />ADDR~ss 595 Court Street NE <br />-Salem, Oregon <br />p~o~ none <br />SIC ConE <br />The DEQ wi]1 send the annual co~glianc~ invoice to <br />the permitte~. <br />Return this complctcd form, che completed Federal <br />form (Notification for Underground Storage Tanks) and <br />any fees owing to: ~ <br />DEQ <br />Business Offce <br />811 SW 6th <br />Portlar-d, OR•97204 <br />E3eh campleced apgiIcation m~sc includa c5e signaturo of the ranlc <br />owner, propercy ovvna u~d the permi«ea. ~~ea if ic is the same <br />pcrson, all 3 signatures are requicr.d. , , <br />