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i <br /> NOTICE OF RESPONSIBILITY ( NOR) FORM <br /> SITE CODE : DATE FIRST REPORTED : <br /> SITE NAME : Cltr� �_ ✓ c; ' <s � r V4 ash SUBSTANCE : 3N) 6G_, l <br /> ADDRESS : 2 D - POOL __[_ I ( _ J\ V , <br /> CITY : l rc, k l-a ,, STATE : C )- ZIP : 9S 07 37 /2 <br /> RESPONSIBLE PARTY : <br /> RESPONSIBLE PARTY CONTACT : t c � J , 7- I- l- ) n care o <br /> 7GV � <br /> TL I1 B <br /> ADDRESS : / S 3live , 11 ,1i ) d Ej St , CITY : STATE : C"/-1 ZIP : s--2o9- <br /> Examples of Reason for NOR (Circle the appropriate example that you want to use) <br /> NEW: X Reason : Owner of propertV since "(DATE )" , where an unauthorized release of a <br /> hazardous substance from an underground storage tank had occurred prior to "(DATE )" > and <br /> corrective action is still required , <br /> Add : X Reason : RESPONSIBLE PARTY -Owner of property since <br /> "(DATE i , ��, ,, �" , where an unauthorized release of a hazardous substance from <br /> an unde _ round storage tank had occurred prior to "(DATE '3 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 />