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3500 - Local Oversight Program
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PR0544508
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
5/31/2019 2:12:41 PM
Creation date
5/31/2019 1:58:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0544508
PE
3528
FACILITY_ID
FA0004718
FACILITY_NAME
CAINS ELECTRIC WORKS
STREET_NUMBER
230
Direction
N
STREET_NAME
CHURCH
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
230 N CHURCH ST
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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i <br /> UST CLAIM APPLICATION <br /> INSTRUCTIONS FOR PAGE TWO',! <br /> �I <br /> j 111. JOINT CLAIMANT IDENTIFICATION FORM <br /> Joint claimants are subject to the same eligibility requirements as thelprimary claimant. When joint claims are <br /> submitted, the Priority Class for the claim shall be based on the lowest priority appropriate for any claimant. <br /> Joint claims must be signed by all claimants and, in the absence of any special instructions, all commitments <br /> and checks for reimbursement will be issued in the names of the primary claimant and the joint claimant(s). <br /> Complete this Section only if this claim is being filed jointly by multil'ple owners and/or operators. <br /> A. Identity the Joint Claimant, mailing address and a telephone I umber where the Joint Claimant can be } <br /> contacted during normal business hours. <br /> If the joint Claimant is an individual or sole proprietor, enter! eir Social Security Number. If the Joint 1 <br /> B. <br /> claimant is a corporation, partnership, estate or trust, enter the Federal Employer Identification Number <br /> (FEIN). <br /> C. The Priority Class for this claim shall be based on the lowestl,.±priority appropriate for any claimant, <br /> including any Joint Claimant. Check the appropriate box to indicate if the Joint Claimant is filing as the <br /> owner or the operator of the tank(s). Check the appropriate box to indicate the appropriate Priority <br /> Gass for the Joint Claimant. ' <br /> it <br /> D. List the dates that the identified Joint Claimant maintained ownership and/or operation of the tank(s). <br /> t !I <br /> IV. CO-PAYEE IDENTIFICATION FORM <br /> Owners and operators can designate a representative who has advanced funds for cleanup as a Co-Payee. <br /> Representatives are usually insurance companies and lending institutions. A copy of the financial agreement <br /> between the Co-Payee and the primarily claimant is to be submitted with this Claim Application. All payments <br /> will be issued jointly to the primary claimant and the Co-Payee. j <br /> A. Identity the Co-Payee, their mailing address, and a telephone number where the Co-Payee can be. <br /> contacted during normal business hours. <br /> i <br /> B. If the Co-Payee is an individual or sole proprietor, enter theirSocial Security Number. If the Co-Payee <br /> is a corporation, partnership, estate or trust, enter the Federal Employer Identification Number (FEIN). <br /> i <br /> i <br /> i <br /> ' I t <br /> f <br /> j <br /> 1 <br />
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