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JOSH SHAPIRO, Governor   |   Michael Humphreys, Commissioner

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For USTIF to process your claim in timely manner, please follow these instructions.

  1. Complete all the fields highlighted in yellow.
  2. Save a copy for your records, once completed.
  3. Email the form to RA-IN-FBSCLAIMS@PA.GOV with the subject line:
    CLAIM NOTIFICATION SUBMITTAL FORM

If you run into issues, please contact by calling 717-783-8093 and follow the prompts for Claims Department. Thank you.

Attachments

FINAL Contracts Entry Data List

Attachment 1 Remediation Agreement
Attachment 2 Bid Cost Spreadsheet
Attachment 3a Figures 1 through 4
Attachment 3b Figures 1 through 3
Attachment 3c UST Closure Report June 1993
Attachment 3d UST Closure Report Sept 2018
Attachment 3e First ECPR July 2019
Attachment 3f Second ECPR Oct 2019
Attachment 3g Third ECPR Dec 2019
Attachment 3h Fourth ECPR Feb 2020
Attachment 3i Groundwater Lab Reports
Attachment 3j Boring Well Logs
Attachment 3k Potable Well Lab Reports part 1 of 3
Attachment 3k Potable Well Lab Reports part 2 of 3
Attachment 3k Potable Well Lab Reports part 3 of 3
Attachment 3l Soil Lab Reports
Attachment 3m Site Plan 1
Attachment 3n Site Plan 2
Attachment 3o Groundwater Data Table
Attachment 3p Soil Data Table
Attachment 3q Potable Well Summary Table
Attachment 3r Potable Well Analytical Tables
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