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(9 Z6Times New Roman Regular\\ipp://pc2.tceq.state.tx.us\hp8150-0427030(9 Z6Times New Roman Regulard T!   _X  HHXp!@ 'XXXX TEXASCOMMISSIONONENVIRONMENTALQUALITY X @--PETROLEUMSTORAGETANK A @C C CORRESPONDENCEIDENTIFICATIONSHEET  * 'LX'XDate:0  0$$0P $$0 P $P $0 $ $0X$$0X$X$0$$0`$$_LPST_ԀIDNo.:0`$`$0h$$0!h$h$0$!$!$$$$$ SiteName:0  0P $$0 P $P $0 $ $0X$$0X$X$0$$0`$$FacilityIDNo.:0`$`$0h$$0!h$h$0$!$!$#'XX'Lբ#'LX'Xf$$$$ SiteAddress:0  0P $$0 P $P $0 $ $0X$$0X$X$($$ 0  0$$0P $$0 P $P $0 $ $0X$$0X$X$#'XX'LK#'LX'X $$ #'XX'L#'LX'X  Thischecklist must accompanyallcorrespondencesubmittedtothe_RPR_ԀProgramandshouldbeaffixedtothefrontofyour  n  _submittal_Ԁasacoverpage.Pleasechecktheappropriateboxforthetypeofcorrespondencewhichyouhavesubmittedtothe_RPR_  2  Program.Checkallboxesthatapplyifyouaresubmittingmorethanonetypeofcorrespondence.Ifyoucannotfindanappropriate L   category,pleasecompletethe"other"section.#'XX'L2#   *ddd Xdd Xdd XH$H$,H!dd +  &8 a  a  &  PROPOSALS 'LX'X -#!  8 -33pH4T#X X;L|$XXH0 # InitialAbatement(1)0 #,$#,$0  ,$ ,$0 ,$ ,$TankRemoval(2)0l,$,$0l,$l,$0;,$,$0;,$;,$Excavation(3)E ,$,$ 0 # WasteTreatment(4)0 #,$#,$$L'L0 ,$ ,$#'L$Lզ ##'XX'L #'LX'X0  ,$ ,$0 ,$ ,$SiteAssessment(5)0l,$,$0l,$l,$0;,$,$0;,$;,$AquiferTesting(6)0,$,$ 0 # _VES_/_Sparge_ԀTesting(7)0 #,$#,$0  ,$ ,$0 ,$ ,$_Qtrly_.GWMonitoring(8)0,$,$0;,$,$0;,$;,$CAPPrep.(9)s,$,$ 0 # GW_Extrac_./Treatment(10)0 #,$#,$0  ,$ ,$0 ,$ ,$SoilVapor_Extrac_.(11)0,$,$0;,$,$0;,$;,$Operation&Main.(12)^,$,$ 0 # SiteClosure(13)0 #,$#,$0 ,$ ,$0  ,$ ,$0 ,$ ,$PlanARiskAss.(14)$L'L0l,$,$#'L$L ##'XX'L #'LX'X0l,$l,$0;,$,$0;,$;,$PlanBRiskAss.(15)I,$,$ 0 # SemiannualGWMon.(16)*0 #,$#,$$L'L0  ,$ ,$#'L$LU##'XX'LՅ#'LX'X0 ,$ ,$AnnualGWMon.(18)0,$,$0;,$,$0;,$;,$ProductRecovery(19)4,$,$ 0 # Otherproposal0 #,$#,$0 ,$ ,$0  ,$ ,$0 ,$ ,$0,$,$0,$,$0l,$,$0l,$l,$0;,$,$0;,$;,$0L,$,$#'XX'L#'LX'X#L,$L,$  ##'XX'Lհ#*eddH!dd H!H$H$e,H!dd +  &8UU &  i.T#Xw ;tXT#X X;L|$XiREPORTINGFORMS -#!a 8 -'LX'Xi1T#XE* ;tXT#Xw ;tXi0 # AssessmentReportForm(_TCEQ_Ԅ0562)0E#,$#,$0*E,$E,$$L'L0 *,$*,$ReleaseReportForm(_TCEQ_Ԅ0621)#'L$L#9 ,$ ,$ 0 # ProductRecoveryReportForm(_TCEQ_Ԅ0016)0*#,$#,$$L'L0 *,$*,$MonitoringEventSummaryandStatusReport(_TCEQ_Ԅ0013)#'L$Lգ#$ ,$ ,$ l1T#XE* 2;tXT#XE* ;tXl0 # SiteClosureRequestForm(_TCEQ_Ԅ0028)$L'L0E#,$#,$#'L$L3#0*E,$E,$$L'L0 *,$*,$FinalSiteClosureReportForm(_TCEQ_Ԅ0038)0 ,$ ,$#'L$L՝#,$,$ 0 # Otherform0\#,$#,$0 \,$\,$0 ,$ ,$0 ,$ ,$0E,$,$0*E,$E,$0 *,$*,$0 ,$ ,$0,$,$02,$,$0;2,$2,$#;,$;,$  #*eddH!dd H!H$H$e,H!dd +  &8 &'XX'L  REPORTS -#!d  8 -'LX'Xr7T#X[|}XT#XE* 2;tXr0 # TankClosure/Removal0 #,$#,$0[ ,$ ,$0[,$[,$  PlanARiskAssessment0,$,$0},$,$0},$},$AnnualGroundwaterMonitoring,$,$ 0 # O&M/PerformanceMon.0 #,$#,$0[ ,$ ,$0[,$[,$0,$,$PlanBRiskAssessment0,$,$0},$,$0},$},$CAPInstallation/Modification w ,$,$ 0 # PropertyDivestiture/PhaseI_ESA_0[#,$#,$0[,$[,$0,$,$CorrectiveActionPlan(CAP)0},$,$0},$},$Aquifer/PilotTestResults#!b!,$,$  #*eddH!dd H!H$H$e,W!dd +  &8#h!"#h! &'XX'L  MISCELLANEOUS -#!$$!# 8 -'LX'X0 # Offsiteaccessassistance0 #;$#;$0[ ;$ ;$0[;$[;$0;$;$0|;$;$0|;$|;$DeadlineExtensionRequest%L#$;$;$ 0 # Tanktightnesstestresults0 #;$#;$0[ ;$ ;$0[;$[;$0;$;$0|;$;$0|;$|;$RequestforStateLead&7$%;$;$ 0 # Requestfor_LPST_ԀWasteCode0[#;$#;$0[;$[;$0;$;$0|;$;$0|;$|;$ClassV_Reinjection_ԀRequestz'"%&;$;$ 0 # NoticetoOwner/Operatorfor_CAS_ԀServices0#;$#;$0|;$;$0|;$|;$PetroleumSubstanceWasteManifeste( &';$;$ 0 # UndergroundStorageTankRegistrationForm0|#;$#;$$L'L0|;$|;$AbovegroundStorageTankRegistrationForm#'L$LՇ%#P)&(;$;$ 0 # Other(anythingthatdoesnotfitintooneofthecategoriesabove)0#;$#;$0;$;$0};$;$0};$};$0;$;$;*');$;$  &+(*  *0  Theproposalforsemiannualmonitoringandannualreport(ProposalActivity17)hasbeendiscontinued.Forsemiannual A,)* monitoring,useProposalActivity16. ,-*+$$ *l ddW!dd W!H$H$l, td , dd , dt +  >+XX ax> Iattestthatallworkhasbeenconductedinaccordancewithacceptedindustrystandards/practicesandadheredto_TCEQ_ x guidanceandrules.IcertifythatIamawarethatmisrepresentationofanyoftheaboveclaimsisaviolationof30TAC c 334.453(b)(1)(E)andthatthisviolationmayresultinthedisciplinaryactionssetforthin30TAC334.453andor334.463and N 334.465. 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