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Get CA CAL/EPA 220 2006-2024

Ram (Attn: name of assigned Cal/EPA EJ Grant Manager) PO Box 2815, Sacramento, California 95812 1. GRANTEE NAME (AS APPEARS ON GRANT AGREEMENT) 2. GRANT NUMBER (ASSIGNED BY CAL/EPA) 3. PAYMENT REQUEST NUMBER . AMOUNT REQUESTED $ 5 4. TYPE OF PAYMENT REQUEST (ATTACH SUPPORTING DOCUMENTATION) Initial Reimbursement Final 6. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) A Non-Profit Entity Federally Recognized Tribe 7. Send warrant to: CONTACT PHONE (WITH AREA CODE) CONTACT NAME ADDRESS .

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