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JAN-03-199E 13:08 LIST CLEANUP FUND 916 227 4537 P.04iO4 <br /> DETAILED REVIEW CHECK LIST* • <br /> Page 3 <br /> Claim No: Claenent plme: <br /> LY3MPLtANC�'DOI�lA/EM"A:T�ON ,.... '. . � .• .__ <br /> ...,DATE ACTIONIRESPONSE <br /> Continued on Reverse a <br /> ICON"1 417onr oF;coxnEC. etcr oa:etNrtriui�eE:',:• <br /> Claimant in Corrective Action Compliance <br /> Clamant NOT in Corrective Action Compliance at the.Time of this Review- 90 Day Leiter Required <br /> ❑ Claimant NOT in Corrective Action Compliance -Recommend Refection <br /> PHJ CHD 1113101 c <br /> L.FAO AGENCY SKMATM DA)E <br /> / A I <br /> CLAIMS REVIEWER SIGNATURE DATE <br /> USTCF025.DET (Rev IM. ) <br /> TOTAL P.04 <br />