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n <br /> Underground Storage Tank Cleanup Fund <br /> DETAILED REVIEW CHECK LIST <br /> Claim No: 0 /41 s� Clalmant Name: <br /> Region : Priority Assigned: She Name: <br /> Otte Reviewed: 81fa "fear: - <br /> T / ' A4 <br /> Revgwen Lead Agenc <br /> ,,, : , 'lMIFIPM+ 98 .. yyrA ', aWe .iE lYi.: <br /> Claimant OwnaNOperstor of UST <br /> Tax Identification Provided <br /> Valid Third Pa Claim <br /> " bfll7 }(E41 t/ERIkJCATiDbf XIIA .; YLO':. ,: <br /> Joint Claimant OwnedO stator of UST <br /> Tax Identification Provided <br /> W.0 <br /> 7M, <br /> Financial Agreement Provided <br /> Tax Iderdiftcation Provided <br /> fJ�a" 1alrTXAiwJq .cf�rroiu, <br /> VERIE7CATJ4N , ;1 :: SIA .: : ° <br /> Tank Description, Tank Use <br /> Tank Substance <br /> Site Map Provided .� <br /> Current Owner/Operator Identified <br /> Dole Slt&Tanks Acquired ✓ <br /> Acquired After 111184 Reaswable Dili encs ✓ <br /> Past Owner/Operator Identified <br /> Other Claims For This Site Submitted ✓ <br /> L�NCS ,, :.: kl .f lt)N " ` NTd ! I:' 3rES ::::: (0.. ',' <br /> Unauthorized Release <br /> Release ReportedlConfirrned <br /> Date Release Discovared Confimted <br /> Corrective Action Required v% <br /> Release Eligible not a spill, overfill, etc - ' <br /> Corrective Action <br /> Reteaee Prior to 111188, CA Initiated by 61"S <br /> Corrective Action In Compliance <br /> Permit <br /> Permit Requifemanis Met by 111190 <br /> Permit Waiver Being Requested <br /> Permit Waiver Grantod <br /> Financial Responsibility <br /> Claimant in Compliance ✓ <br /> VERIJ7Ct1TJC1N. . , : , iiI(Ad. 4;: NYO : i <br /> Lawsuit, Insurance Claim, Settlement <br /> Date Piled - Date Completed <br /> Amount Received <br /> ft?IG�IrT1tY 15 lF111 t iV t Si '' a119 9J <br /> Y1 A' : i.' <br /> J!1(1.c <br /> Original Signature(la) <br /> Aulharaed Representative Statement <br /> Joint Claimem Si nature e <br /> USTCF025. DET (Rev VaS) <br /> sed GLL '0I1 22TOP90GOETC r aifld dni%lu3izl 1Sfi E2 : 11 L6/50/'30 <br />