SITE INFORMATION AND CORRESPONDENCE

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UM TAM 'I'his checklist is to assist the claimant to ensure that all required documentation is submitted with this application. It is recommended that the claimant label each document with a reference to the Claim Application section. It may be necessary to attach additional pages to respond to the questions asked. For example, if the claimant's name consists of a number of persons which do not fit in the space provided,they can be listed on a separate page and labeled "Claimant's Name". CHECKLIST OF REQUIRED DOCUMENTATION ESTIMATE OF COSTS If Third Parry Compensation costs are being claimed,a copy of the final judgment, court—approved settlement,or arbitration award MUST be submitted. SITE MAP A site map drawn to scale which includes a north arrow and distances relative to the nearest public roads MUST be submitted. r� DATE CORRECTIVE ACTION INITIATED If the release was discovered prior to January 1, 1988,and corrective action was initiated after June 30, 1988, claimant MUST document that corrective action was not directed prior to January 1,1988, PRIORITY CLASS A Documentation showing that the property was owner—occupied at the time of the discovery of the release (i.e..property tax bill) MUST be submitted. i ■ PRIORITY CLASS B `� The annual receipts and supporting documentation that MUST be submitted with this claim application in order to support the request for placement in Class S are described in the PROGRAM INFORMATION of this Application Package. Cities, counties,and districts MUST submit a copy of the annual Report of Financial Transactions as submitted to the State Controller's Office for the latest fiscal year. Nonprofit organizations MUST submit a copy of their annual fiscal report filed with the Registry of Charitable Trust,including all affiliates,for the latest fiscal year, or a copy of their state and federal tax records for the latest fiscal year, including all affiliates. I� FINANCIAL RESPONSIBILITY If the claimant is subject to the financial responsibility requirement,a copy of the Certification of Financial Responsibility that is on file with the regulatory agency MUST be submitted. I� UNAUTHORIZED RELEASE OF PETROLEUM Documentation of the discovery and the reporting to the regulatory agency of the unauthorized release of petroleum subject of this claim application MUST be submitted. ' PERMIT TO OWN AND/OR OPERATE UST A copy of the permit to own and/or operate the UST(s) issued on or before January 1, 1990,or documentation of not being subject to the requirement as of January 1,1990, or documentation requesting a waiver MUST be submitted. CORRECTIVE ACTION COMPLIANCE Documentation MUST be submitted showing the claimant is in corrective action compliance with corrective action orders and directives of the regulatory agency. CO—PAYEE AGREEMENT A copy of the financial agreement between the claimant and any designated Co—Payee MUST be submitted. (REVISED 1194) (SEE FACING PAGE FOR INSTRUCTIONS) PAGE 11