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NOTICE OF RESPONSIBILITY (NOR) FORM <br /> SITE CODE: 2083 DATE FIRST REPORTED: )q /3 <br /> SITE NAME: Tr Cv QIf i ce P 10 z-a SUBSTANCE: 12o34 <br /> ADDRESS: 324- E. E leve-niL S+i-eet <br /> CITY: T'ra c,,.i STATE: e,A zip : R53 ?(o <br /> RESPONSIBLE PARTY: -i✓rQ cy D-f-F;tee. T i a za L LG <br /> RESPONSIBLE PARTY CONTACT: a e, ) R . BI a c�k <br /> ADDRESS: 2423 W. Mat's., LaneSv`zo2 CITY: 3+be_k+.yrx STATE: 614 ZIP: 95.2 � <br /> Examples of Reason for NO /to example that you want to use <br /> Chazardous <br /> agince <br /> on: Owner of property since "(DAT'EOgl.2oog)„ <br /> where an unauthorized release of a <br /> from an underground storage tank had occurred prior to "(DATE y , andstill re uired. vS108/ZDOg j <br /> Add: X Reason: RESPONSIBLE PARTY-Owner of property since <br /> "(DATE )" , where an unauthorized release of a hazardous substance from <br /> an underground storage tank had occurred prior to "(DATE )" and <br /> corrective action is still required. <br /> (This form will come from the inspectors with the pertinent information required for the Site letter and Nor) <br />