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L <br /> Underground Storage Tank Cleanup Fund <br /> DETAILED REVIEW!CHECK LIST <br /> Maim No: 0*6 2 Claimens Name: - <br /> Replon: Priority Assigned; S Me Name: A <br /> Data t't flawed: �r9 Site Addm*,N: -/// e <br /> �a�iewar Lead Agency- 14 � <br /> :... .. TiION, 77— jyq <br /> Claimant Owner/Operator of UST <br /> Tax ldentifrcetion Provided <br /> 11:O% I .M.WQF.coST8. <br /> Valid Third Pam Claim <br /> .. N�.• •-.:-:.: :.:..•• . . . .. . ... . : ,�llcR1�1�4TtON::•:.... ;; --. ; .;:, ::�itfA.:': :.�5'ES�:: NQ <br /> Joint Claimant OwnertO retor of tJST <br /> Tax IdenWiication Provided <br /> Wo <br /> Financial Mreernent Provided <br /> Tax Identilleation Provided <br /> . YONYYT,r1'A'Ii4:ipL:S�. ,CR TJpi11t : .. Vii R1FC�4ilt?N 1tf/A': :::.tom NO <br /> Tank Dmoripfion: Tank Use <br /> Tank Substanoe <br /> Sita Map Provided <br /> Curmnt Owner/Opera#os Identified <br /> Data Siteffanks Ac uirad fo a <br /> AogUlted After 111184 Reasonable Diligence <br /> Past Owned0 erator Identified <br /> Other Claims For This Site Submided <br /> VL�R[1~lCi�T N !Y/}E::' "."YJ*S Nib. <br /> Unauthwrized Ralenee '/ <br /> Release ReportedlConfirmed 1� <br /> Date Release Dismvered Confirmed <br /> Corrective Action Required <br /> Aefease Eli ib a note 111, overflA, etc <br /> CorreeMm Action <br /> }release Prior to 1!1188, CA Initiated by 6 AMO <br /> Comore Action in Com Bance <br /> Permit .q <br /> Pefmit Requirements Met by 1MMO 1 <br /> Penni!Waiver Being Requested V <br /> Permfi Waiver Granted <br /> Fhtan*101 Rdeponsif efts <br /> Claimant In Complianoa <br /> 5A. .. <br /> Lawsuit, Insurance Cfaim, <br /> Settlement T, <br /> Date Fled-•Dais Completed <br /> Amount Reoaived <br /> .COMMOANONS <br /> Original Si nature s <br /> Authorized Representative Statement <br /> Joint Claimant 3I nate s) <br /> USTCF025.OET(Rev 1196) <br /> 2O0 EBO'ON e2T079V60�!i6 QNfld dF1NUB19 ISn 9E:TT 96/LZ/60 <br />