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r , <br /> DETAILED REVIEW CHECKLIST <br /> CLAIM NO.: Q j REGION: COUNTY: 5�.. CODE:' d <br /> PRIORITY AS IGNED: LEAD AGENCY <br /> CURRENT RANK: (,. AND <br /> DATE REVIEWED: —/ — CONTACT PERSON: <br /> REVIEWER: PHONE NO.: O 7 <br /> SITE NAME: 4 lxf <br /> SITE ADDRESS: �M - r 7 <br /> CLAIMANT INFORMATION iACC.1 EJ. HOW INFORMATION WAS VERIFIED <br /> 1. Claimant Identification <br /> 1. Claimant is/was the owner and/or operator / <br /> of the leakingUST? — L/'q W"4'�xzW q� <br /> 2. Have all applicable past and current UST v <br /> owners/operators been identified? o <br /> 3. All required tax ID numbersprovided? "r <br /> 4. Date siteltanks a mired verified? <br /> II. Statement of Costs <br /> 1. Valid third party claim? N <br /> 2.Claimed corrective action costs <br /> exceed $10,000? <br /> III. Joint Claimant. I <br /> 1. Joint Claimant is an owner and/or operator? ` h <br /> 2.Tax 10 numberprovided? <br /> 3. Joint Claimant's priority class verified? I <br /> IV. Co—Payee , <br /> 1.Tax ID Noprovided? <br /> 2. Mailing address! hone no.provided? <br /> V. Contamination Site/Occurrence Descri tion* <br /> 1. Description of tank and use verified? L A <br /> 2. Registered farm tank? s o <br /> 3. Leaking tank contained eligible substance? <br /> 4, Is there any evidence that the UAR was the <br /> result of a spill, overfill or gross <br /> negligence? b I h� <br /> 5. If claimant submitted more than one claim <br /> for the site,each claim is for a <br /> separate occurrence? <br /> 8. Site map provided? <br /> VII. Priority-Class Worksheet ! <br /> 1.Claimant's priority verified? 9 Z2 Q <br /> 2.Claimant was both the owner and operator <br /> at time of leak discovery? Yes o <br /> 3.Claimant is the current owner and operator? Yes No/NA <br /> 4. If either question - No, other party(s) <br /> priority class was verified? <br /> Vlll. Priori Class Designation <br /> A. Priority Class A <br /> Residential Motor Fuel Tanks <br /> 1. UST located at the residence of a person <br /> and property zoned residential use <br /> only at time of leak discovery? <br /> 2. UST located at property improved by an <br /> owner—occupied single family <br /> dwelling or duplex at time of leak <br /> discovery? <br /> 3. UST was not used for agricultural purposes <br /> or for resale on or after ill 85? <br /> OR <br /> Residential Small Home Heating Oil Tanks <br /> 4. UST located at the residence of a person <br /> at time of leak discovery? <br /> 5. UST located at property improved by an <br /> owner--occupied single family <br /> dwelling or duplex at time of leak <br /> discovery? <br /> 8. UST has a capacity of 1,100 gallons or less? <br /> 7.UST is used only to store home heating oil <br /> for consumptive use on property') <br /> 8. UST was not located on agricultural property <br /> on or after 111185? <br />