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. <br /> ;I <br /> UST CLAIM APPLICATION, <br /> INSTRUCTIONS FOR PAGE ONE <br /> I. IDENTIFICATION <br /> CLAIMANT IDEN <br /> y .i <br /> A. Check the appropriate box to indicate if the claimant is the owner, operator or both of the petroleum <br /> underground storage tank which is the subject of this claim. <br /> B. If this application is being submitted for the first time, ch�ck the box indicating "New"; if this <br /> application is being resubmitted, check the box indicating Resubmitted" and list the prior claim k <br /> I number. <br /> C. Identify the claimant and mailing address, and list a telephone number where the claimant can be <br /> contacted during normal business hours. If this claim is being filed jointly, the name in this section will <br /> be considered the primary claimant and will receive all original correspondence and checks. i <br /> D. If the claimant is an individual or sole proprietor, enter their Social Security Number. If the claimant is <br /> a corporation, partnership, estate or trust, enter the Federal Employer Identification Number (FEIN). All <br /> payments from the Fund will be reported-to the IRS and ;the Franchise Tax Board. <br /> E. Identify a contact person who can answer any questions iabout this claim or the site. The telephone C <br /> number should be one where that person can be reached during normal business hours. <br /> E. F. Check the appropriate box to identify the claimant's status. <br /> .i <br /> II. ESTIMATE OF COSTS <br /> A. Identify the eligible corrective action costs incurred for work performed prior to the date of submittal of <br /> this application. Supporting documentation (invoices, contracts, bids, cancelled checks) will be <br /> required at a later date to support the costs requested, ar,d are not to be sent at the time of the <br /> submittal of this application. i <br /> e B. Identify the estimated eligible costs necessary to complete the work currently underway. <br /> f i <br /> I C. Identify the estimated future eligible costs to complete the corrective action. These costs should be <br /> based on best available estimates. <br /> i <br /> D. If applicable, identify the total amount of Third Party Compensation costs being claimed. Refer to the { <br /> r Program Information Section of this package for definition of Third Party Compensation Claims and for <br />' <br /> i requirements and qualifying costs. � <br /> E. Enter the total estimate of costs. <br /> I E <br /> i <br />� I <br /> i <br /> i <br /> i <br /> 1 <br /> e <br />�, i <br />