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, <br />Ms. Ann Koiata <br />Page 3 of 3 <br />•:1 <br />9 <br />Additionally, IDNR regulations require that Well Abandonment Forms be submitted to <br />IDNR. <br />If ,you are eligible and will be seeking reimbursement from the ELTF for well <br />abandonment activities, IDEM requests that you submit a report within 60 days from <br />receipt of this letter containing the following: <br />• Brief summary of activities performed <br />• Completed "Record of Water Well' State Form 35680 for each well (monitoring <br />and treatment wells) signed by the licensed Well Driller <br />• Map showing well identifiers and locations <br />• Table including well identifier, depth and diameter <br />Please note that as required by 328 IAC 1-3-1(c) you have nine (9) months to <br />submit all claims for reimbursement of costs from the Excess Liability Trust Fund after <br />the fund qualifying occurrence is granted a status of no further action (NFA) by the <br />administrator. In addition, all -re -submittals associated with any disallowed cost must be <br />received by the department within 12 months after the denial of the claim. <br />If you have any questions, please contact Jill Berry at (317) 234-0981 or toll free <br />from within Indiana at (800) 451-6027. She may also be reached via email at: <br />iberry(a?idem.IN.gov. <br />Sincerely, <br />Timothy E. Veatch, Chief <br />Leaking Underground Storage Tank Section <br />Underground Storage Tank Branch <br />Office of Land Quality <br />(317) 234-0980 <br />tveatch(a-idem.I N . qov <br />Enclosures included with IDEM file copy only <br />ecopy:IDEM File <br />Mark Basch, IDNR Division of Water <br />St. Joseph County Health Department <br />Mr. Edward B. Stefanek, Weaver Consultants Group <br />