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r � <br /> UNILGROUND STORAGE TAMC CLEANUP L& <br /> J.' <br /> COMPLIANCE REVIEW FORM <br /> ..... "Ci�AIMANTNAME. <br /> SY')t`E_"DRESS <br /> G'LAilN PRiORiTY r DEDIICMLF V <br /> NMLT1ipI:E CI.wiM a <br /> REGIt�rf, � <br /> I,�AI�AGEN+GY ,a1 �t <br /> DATL.BE�►iEWED. <br /> RELE49,9 CONHIRMA27ONDAM Record the datt the release was confirmed by the local agen�7r <br /> FIRST DIRECTIVE Record the state of the fust directive issued by Iocal e0oaM Hoard: <br /> GROSS NEGLIGENCE: Record airy evide r e of grass negligenea famd in the local a6awy/Rept Board file: <br /> i <br /> INELIGIBLE COSTS: Rewtrd any evidence of ineligible Coats related to this Claire: <br /> 1 <br /> SITE CLOSURE R`site is dosed,note date and get copy of eloam tette for Close Oua Unit <br /> SET MWE <br /> i. <br /> �I3 x <br /> 6' <br /> OTHER FUNDS. Does evidence indicate that claimant has received funding from other sourccs7 <br /> SEMEMENT REVIEW If so,has the appropriate documentation been roviowed by the Scttlanents Unit? <br /> er: TQr>~: - K <br /> ELIGIBILITY Does evidence indicate that dg mart owned and/or operated <br /> ELIGIBILITY Does evidence indicate that joint claimant is eligible to (r <br /> 8t paRitipate in the Fund? <br /> CO-PAYEE AGREF-WENT If a <br /> cO-PByee exists,ltas Ute cO-Payee agreement been appmved by the Settlements CTnit? <br /> 'E <br /> :CONT:S1titINATEDS)� I)ESERYPTIUI� . r <br /> a F <br /> TANX/SI/BSTANCE Dots evidence indicate that u6tVsubstancc is eligible? <br /> INTU021COM(New 1 t/97)_ <br /> Psdt 1 t <br /> 204 692. awj dnNu3-0 isn L7=S i 86i i 1:20 <br />