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_�- �-••« u.3, t.uamr*ur rujND NU.8b4 P02 <br /> r � DETAILED REVIEW CHECKLIST <br /> •' USTCF02S.DET Rev. 1185 <br /> Claim No.: _�- Claimant Name -- —V 7 _ <br /> Region: <Odoritv Assigned: Site Name: T <br /> Date Reviewed: Site Address: <br /> Rsviaar _ -- Lsxd A nr: <br /> . <br /> CLAI�LIlif7rt,�D�flT+F1�4�i'GN ......... . ... .. <br /> T' rilt0l' W tl�-1 <br /> idantlkoWn Provided r ID :r- - <br /> 7-0 <br /> Val d 1?hird Darty Cle�irn _ <br /> Joint Claimant OwnedO eratar of UST <br /> Tax Identification Pmvided <br /> FCA <br /> TK3N • .... alfl :"1 ' .NG'.. <br /> Finand-J Agreement Provided �- <br /> Tax Ider0cation Provided <br /> srrS•01s?'OPYlMVK nFSCRIMON <br /> Tank Descri ion,Tank Use <br /> Tw*Sube3wce <br /> Site Map Provided <br /> Cuntm OwnerlOperetor Identified <br /> Date Sit rwks Acquimd _ _... <br /> _ acquired After itlMl Zeesonable Dil" e� <br /> _ -Pact OwnaYO rater Identified <br /> Other Claims For This Site Submitted <br /> L•lG dirYMoUJR$=Eh(� _ _. �i4*Rll3iCdTIDN AtiA YES ' NO <br /> unauthorized Roi¢ase <br /> Releass RM2ftdfCanfirrned <br /> Date Release Aisoavere d Contemned ' <br /> Correecuve Action Required <br /> .. Relear,e Eigiblu Rot a spill.overfill,elite '$-�-A C) 8✓`- t} <br /> Carracdve Actlon j <br /> CU <br /> VAAJtl (C ' <br /> If Relenae Discovered Prior to 1!1/08, <br /> Comctive Action lnifiaWd by 6/3{t?88 <br /> Gorreetive Action In Compliance _ <br /> Pprmlt I /] <br /> Permit RegiArements Met by 111100 <br /> Permit Waiver Behg R T nested <br /> Permit Waiver Granted <br /> Financial ResponalbMilY <br /> Qlrranant in Cam ®rice <br /> srr� ti�1 ice:•: :': NOAOL <br /> Lawsuit, Insurance Claim.Settlement , <br /> Date Feted-Date Com ted <br /> Amount Remlyed <br /> Authorized Representative Statem <br />