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•per r _ ; <br /> r, Underground Storage Tank Cleanup Fund 3K <br /> .DETAILED FIEVIEW{CHECKLIST <br /> octattn fea.: Clalment attt+s. �,t !1f �? 4*'We'AA@- A-r _ . <br /> Orlwo• A <br /> r Aed: Site Name rA•+G_.4� a� <br /> ` ss__...� " _Z.e�.�._-- : <br /> Data RwA*v edtSite Addrea8:/ _. ! <br /> .,. Clalman oro >sr tof USY <br /> _ c <br /> i Tax tIentNicatian Provided <br /> VAlid TR€rd Deny Cfatm <br /> Joint Claimant awnerl00arator of UST .: <br /> Tax ldentificatlon i�rovided <br /> Financial A reemen Provided - r <br /> Tax i claliA r tont PrClrld <br /> Tank Deacdoflon.Tante Use <br /> Tank 5utstance ! <br /> :Site Ma Provided' i... • ' <br /> GurrenCBwnertC?aarator tdMi fleet <br /> Qats SiterTanks Acctuired '� <br /> A ulred Atter 111!$4lRsasonabie plli tart l <br /> Paw OwnerlOperator Identified w _ <br /> her Claims For This Site Submitted <br /> Unauthoriz#d fietetlaa " <br /> Release Reyotted/Conifmrted _ <br /> Data Release Discovered Confirmed r <br /> Corrective Action Required <br /> - <br /> Reeiease Etiftible not a Viii, ovartll!etc ��_-._-.:, '•.� <br /> Corraodwv JWIon <br /> Release Pripr to MISS,GA tniit ted by 61 <br /> Gorrt3cttus Ik on toam llahce. <br /> -.,..- ._ <br /> i�anntt - , .. <br /> Permit Rs ulramCtt Met 6v 1/1490 .,, <br /> _ - <br /> Permit waiver aehut <br /> : Patmlt Waiver t"als3nt6d <br /> Financial Raftoontbitlt�_ <br /> Gla€mant In Compiiiattce <br /> Lawsuit,Insurance Claim.Settlement -. :_ .:.. :.--.- - -4 <br /> # Date Filed Date complated <br /> Amttttnt-ft6Ceived . <br /> t3t€amat Stmo fives - * <br /> Authorin d R eoresentative-5tatemont <br /> Joint claimant ftniturow <br /> USTCE025.DET(Rev.lift) <br /> ;i <br /> Std 6s9'tai € (MA df7W3M 15(} PT 6: L6/t7Zz60 <br />