SITE INFORMATION AND CORRESPONDENCE

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'i _. VlGRI LAS QFSHE.E�" Please refer to the Program Information Section of this package for Priority Class requirements and doucmentation required to I be submitted with this Claim Application to verify priority being claimed. The Priority Class assigned to this claim is based on the priority of the Claimant (identified on Page One), any Joint Claimants (identified on Page 2),and the priority of all other tank owners and operators(identified on Page 4). A. PRIORITY OF THE CLAIMANT j The Priority Class the Claimant is eligible for: A C D B. PRIORITY OF JOINT CLAIMANT(S) ; u When there are multiple owners and operators as Joint Claimants. the Priority Class for the claim is based on the { lowest priority appropriate for the Claimant and Joint Claimant(s). Identify the priority Of any Joint Claimants as listed on Page 2: i I JOINT CLAIMANTS NAME The Priority Class this Joint Claimant is eiiaible for. A B C D �I JOINT CLAIMANTS NAME The Priority Class this Joint Claimant is eligible for: A C D C. PRIORITY OF OTHER TANK OWNERS AND OPERATORS When there were other tank owners and operators at the time of the disc) very of the unauthorized release, or at the time cf application sucmittal•the Priority Class of the claim is based on the lowest priority appropriate for any of these owners and operators. List the other tank owners and operators.a the time of the discovery of the unauthorized release and at the time of application submittal as identified on Page 4. Identify the appropriate _ Priorty Cfass for each 'I - - -- NAME OF TANK OWNER AT TIME OF DISCOVERY OF RELEASE NAME OF TANK OPERATOR AT TIME OF DISCOVERY OF RELEASE i NAME OF TANK OWNER AT TIME OF APPLICATION SUBMITTAL NAME OF TANK OPERATOR AT TIME OF APPLICATION SUBMITTAL r I D. PRIORITY CLASS CLAIMED FOR THIS CLAIM APPLICATION The Priority Class claimed should be the lowest Priority Class appropriate as shown for any of the above. A B JF-i C ❑ D (REVISED 1;94) (SEE FACING PAGE FOR INSTRUCTIONS) PAGE 5 j 1 I 1 i ;