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10/24x95 12-.06 UST CLEANUP FUND 912094640138 r+u..'rj� -i <br /> �. L) <br /> Underground Storage Tank Cleanup Fund <br /> DETAILED REVIEW CHECK UST <br /> Claim No: Q�Q Claimant Nems: <br /> Ragion: PNaffty Assigned: Silo Name: .� • �r <br /> Dau Reviewed: , Site Address: <br /> Reviewer: Lead A gw1cy: <br /> -Jm AAtAArnvEN <br /> TIFICATlOhf :: :....:., ". ... <br /> Clalment Owner/Operator of UST <br /> Tax Identification Provided <br /> ESTIMATE OF-COSTS _.: .:......:.�r�1r-►cAi~roly _..... :., WIA:' <br /> Valid Third Party Claim <br /> JOINT-Cr<:A1MAHT -.., C - .. <br /> ATIDN ihtfA :YES.;' 7YfCI'.Mi <br /> Joint Claimant Owner/Operator of UST ✓ <br /> Tax Identification provided ✓ <br /> CO PAYEE VERIFICATION 'NIA YES ' NO <br /> Financial A mement Provided <br /> Tax Identification Provided ✓ <br /> &ITE>;M1StORYMANC DESCRIPTION MR)MATION WA YES -NO <br /> Tank Desai tion, Tank Use � <br /> Tank Substance <br /> Site Map Provided ✓ <br /> Current Owner/Operator identified / <br /> ❑ate siterranks Acquired <br /> Acquired After 1/1184 Reasonable Diligence <br /> Past Owner/Operator Identified ✓ <br /> Other Claims Fos This Site Submitted <br /> ELK3181LaY REG UYZEMlENTS VERIFICA77ON NIA YES No <br /> Unauthorized Relemm <br /> Release Reported/Confirmed <br /> Date Refease Discovered Confinmd <br /> Corrective Action Raquirsd ✓ <br /> Release Eli 'bfe (not a spill, overfill, etc <br /> Corrective Acdm <br /> Release Prior to VIM, CA Initiated by 13/30/88 <br /> Corrective Action in Com lienee <br /> Permit <br /> Permit Requirements Met by 111/90 ✓ <br /> Permit Waiver Being Requested <br /> t Permit Waiver Granted ✓ <br /> Mrranchd Reepons4bii4 <br /> Claimant in Compliance <br /> STATEMENTS <br /> LawsA Insurance Ctai m, Settlement +� <br /> Date Filed - Date Completed <br /> Amount Received <br /> CERTiF1Clt TIONS - : tflrRfF3CAT14N 7 7r:W;4 <br /> _Nglquill Si nature s) <br /> Authorized RepreseniaWe Statement <br /> Joint CWwant Si attires Post-ft-brand tau tmnsmittai memo 7671 1 lot pages <br /> 1b From, <br /> tJSTCF026.DE l'(Rev E5) Ca <br /> J <br /> D PL ` Phone �+ 3 <br /> .fes ✓ <br />