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1 <br />~~~`°~_rv DE~''~`i'~~I~1T O~ ~i~t~'V'I~O .Ni1~~'~'AL Q~.T <br />.!i~i'7~~RG~RO~T~I7~ ST(~RA.GE TA;.~i ~RO~~i17I ~ <br />?~Rti'~~T ~ ~.'~'~;~CA.'~IOi~ - <br />TP~.NK O~"N~~ <br />PL.~tS~ PRIM ClEtliLY <br />NaM~ <br />ADDR~SS _ <br />ADDRFSS ' <br />X <br />r,~xx owr~z srcvarvr~ <br />DaTz <br />PHON~ <br />PRQ~~Z"Y O~i~iV'ER <br />PLF.1S~ P.4tM [7.E~lRLY <br />VPM~ Marion,County <br />riDARESS lOQ High ,St NE <br />Salem OR 97301 . <br />~ <br />PROPFRTY O `u7ilR£ <br />~ ~ <br />p~ PRIM CLc,1RLY <br />~~ Marion County <br />ADDRESS 100 High St NE <br />Salem OR 97301 <br />X ~ <br />t~rrrr~ srcxArvaa--~_ <br />PERMZT FEE ASSESS~ _ <br />19$S - I99~ 525 pe~ year for e~ch tank <br />^ ranks ng ~25~ ~ = S :c ~ y=s --~5 <br />1994 - c~rren~ year ~ ~35. pe; year for. ~c:~ tank <br />_ tanks ~ ~~5 cz = ~ x ,; yrS = ~ <br />AMOLN'~' R~Il'ITJ~.D ~265.00 <br />Ownas of exiscing caaks, r~ste:ing for the first timt, ne~d co <br />suomit ~e,rs for sll years, 1953 throu~hh ihe currem~ yeac. <br />~`ACII~fiY <br />~ P~ PRIM' QFw Rl v <br />N~.~ Former Chevron Station <br />A.p77~s 595 Court Street NE <br />-Salem, Oregon <br />PHONE none <br />SIC ConE <br />The DEQ wi]1 send the annual com~liance invoic~ to <br />Che permitter. <br />Re[urn this complctcd form, ~he completed Federal <br />form (Notificadon for Underground Storage Tanks) and <br />any fees Owirig Co: ~ <br />DEQ ~ <br />Business Office <br />811 SW 6th <br />Poniar~d, OR•97204 <br />Each compl~ced appiication m~st includt ~ha signature ef the tanlc <br />owner, property ovmer uid the pzrmic[ee. ~~ea if ic is the same <br />person, all 3 signatura are requirr.d. , . <br />