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�_. Undergrowd Storage TankCleanup P r = <br /> DETAILED REVIEW CMECKUST <br /> f Ctcbtnant Name: _ y... <br /> 1 <br /> -- -- <br /> FtMorl;_ E._�Prlari�.A�clenod: Site Name <br /> • ...—. <br /> omte Rovi®w .A-A-4 <br /> ev- -- --.d A - <br /> n. <br /> CtairnM Owner/C rator of 11 - <br /> L�Tax Idem # tion Provided. <br /> ___..Valid Third Party Cialm•, _ _ •....._._—__...... <br /> Joint Clalment Owner/ rotor of UST <br /> Tax identification Provided,.... -'- <br /> : a fir" r Fr wn C", <br /> i, <br /> Financial Agmerngrit Prgvld®ti --�-�— <br /> Tax tdantlfication Provided - <br /> l...., k <br /> Tank 0620HERIon.Tank Use _ <br /> Tank Substance <br /> 94e Ma Provtdsdde <br /> Current OwwnarMpamtor Identlflatd _ - <br /> Date SitelTanlcs A red --- <br /> uired After <br /> P a Owner/Opernior Identified <br /> Other Claims For Thia Site Submitted <br /> 7 77777"'F <br /> UnLuthorizod Rolooco <br /> Ralema rted/Contfrme --- - <br /> Date Retease Glscovered Confirmed _ <br /> Corrective Action Reauhed _ -- <br /> Release Eligible(nota sal,overtlll,, G_ - -.-••- `� <br /> Corrcedva Action <br /> Release Friar to 111188,CA Inhiated by 8 _ <br /> Corrective Action In Co hance_., <br /> P+rrlr=lt <br /> pem*Requirements Met by V M9 <br /> Permit Waiver Bain Re u sled <br /> Permit Waiver Granted <br /> Financial Rcoponalbifit I <br /> (._.. Cfaimrnt in Comohrtnce ---------- <br /> Lawsuit. <br /> _. --Lawsuit.Inburkn.s Claim:Settle- _ment- <br /> }} r <br /> Gats Filed-Data Comolatad __.1.. <br /> Amount Received - - ._._... <br /> -'- <br /> Authorized Repreacniathro Statement --•---- ----.. — � <br /> Joint Claimant Signatur@(V_1,_-- -,....,._ _. .r - _ i ✓_.. <br /> USTCF026-DET(Rev.l/9Sf <br /> Fod B20'DN QNnA dflNU3-13 1Sf1 9280 L6/TT/L0 <br />