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NTENTS <br /> APPLICATION CO <br /> Please note that general instructions for completing this Claim Application <br /> are found on the next facing page. Individual page instructions are f <br /> contained on the page facing the corresponding Claim Application page. <br /> SECTION PAGE <br /> Claimant Identification 1 <br /> II. Estimate of Costs <br /> III. Joint Claimant Identification 11 <br /> V. Co-Payee Identification 2 <br /> Iy <br /> V. Contaminated Site Description 3 <br /> j 3 r <br /> VI. Regulatory Agency <br /> VII. Site History <br /> 4 <br /> i <br /> VIII_ Priority Class ' crksheet <br /> IX. Priority Class Designation 6 <br /> Class A 6 <br /> I <br /> Class B <br /> Class C j 8 <br /> Class D 8 <br /> 9 <br /> X. Financial Responsibility <br /> 'i <br /> XI. Statements 10 <br /> XII. Supporting Documentation Checklist 11 <br /> XIII. Certifications and Agreements 12 <br /> 13 <br /> XIV. Verification <br /> � II <br />