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_:,✓ _CC17'ib+YJl �j NO.4t�1 N0.451 <br /> Underground Storage Tank Cleanup Fund <br /> DETAILED REVIEW CHECK LIST <br />+io: i f; �f 4laimart Name: <br /> Priority Assigned: Sit. mama: J <br /> ���r.��� YDS Nd <br /> avlewad. _ // Site Address: <br /> Lead Agency: <br />:ant Owner/Operator of UST NNW <br /> aenti`.�cabon Provided <br />'TE l 'COSTS:..: 1C.4�lflM <br /> :MA <br /> Third P <br /> Claim <br /> : 1F1CA�°YON <br />�iaimaTit Owner/Operator of UST <br /> tentiAca6cn Provided <br /> FEE. ...... <br /> y <br /> 1�GA�"f©nl <br />�iai Agreement Navided NlS:.c <br /> ientifica5on Provided ✓ <br /> STQRYI7'It1 a11K:itRlPT7fi}N <br /> Description, Use Tank />IRT•7C�17Ji1[" �i3:'" r.ETES" :Nra:= <br /> Substance <br /> iev Provided <br />:t 4NnedOperator Identified <br /> 5ltel7anks Aoquired y <br /> ed After 1!1184 Reasonabie Diligence l <br /> 4nerl0 erator Identified <br /> Claims For This Site SubmittedAFY <br /> r. <br /> razedRelease :"fJERi1A77C1� <br /> e ReporledlConfirmed <br />:a4ase Discovered Confimr)ed �- <br /> INe Action Required <br /> e El able .not a spill. oveMii etc �. <br /> re Action <br /> L- Prig-to 1!1188, CA Initiated try 60/88 �- <br /> ive Action in Co lance <br /> Requirements Met by "/1190 <br />"'Jaiver Being Requested <br /> Waver granted ✓ `� <br /> 4eaponsibl lity <br /> it In Compliance ✓` <br /> lin .... . , : . .. . <br /> :..... iRJF3I4aCiht9N :... <br /> inaurance Claim, Saftoment <br /> ed- Date Completed v' <br /> Received <br /> Si nature(s) <br /> ed Representative Statement <br />�imant Signature(s) <br /> 5-DET (Rev U95) Post-It"brand fax transmittal memo 7671of pages ► 3 <br /> To A [FromCo. 5Ott <br /> .Deptt1-1 one 4 <br /> � <br /> Fax# Fax# <br /> bel, l <br />