Res 1998-049 - Laserfiche WebLink

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I SECTION IV. TOTAL REIMBURSEMENT REQUEST (continued) I 2. 'The lNRCC has a required owner/operator contribution or "deductible" that must be met before costs can be reimbursed. The required deductible is based: I 8 how many single petroleum storage tanks the applicant owns or operates in Texas; 8 if specific corrective action milestones are met; and 8 the number of occurrences when the application is determined to be administratively complete at the TNRCC. I An initial deductible is required for each Occurrence (LPST ID Number. the deductible may increase based upon the failure to meet spedf"ac corrective action milestones). The deductible, or "owner/operator contribution" will be as follows: I NUMBER OF REQUIRED FAILURE TO F AD..URE TO F AD..URE TO SINGLE DEDUCTIBLE SUBMIT A SUBMIT MEET PETROLEUM ($) SITE AND RECEIVE THE GOALS IN STORAGE TANKS ASSESSMENT APPROVAL THE APPROVED APPLICANT OWNS PRIOR TO FUR. CORRECTIVE OR 12123196 CORRECTIVE ACTION PLAN OPERATES IN ACTION PLAN BY , TEXAS PRIOR TO 12123198 12123197 less than 13 tanks; $ 1,000 $ 2 ,000 $ 4 ,000 $ 8,000 I 13 to 99 tanks, inclusive; $ 2,500 $ 5,000 $10,000 $20,000 100 to 999 tanks, inclusive; or $ 5,000 $10,000 $20,000 $40,000 I 1,000 or more tanks. $10,000 $20,000 $4Q,OOO $80,000 If a site bas received a closure letter and bas a subseauent release on or after 9/1/95, the deductible will be $50,000. I a. Number of single petroleum storage tanks owned or operated in Texas: Three (3) (AilJ)Q"O b. Enter required deductible: I ............................................................................. 3. Provide the following information in order to calculate the total reimbursement request for this application: I a. From the Reimbursement Claim SummaJ:y (Section V), provide the total cost for corrective action perf(} , ............................................................................. b. Enter the required deductible amount: I {Same as line (1.b.)}: ........................................................... c. For the corrective action expenses requested to be reimbursed in this application, provide the amount of reimbursement that bas already been received for these expenses or for which a claim was fIled prior I ............................................................................. Insurer name: I Policy number: AI of / / (date), insurance reimbursement bas been (check one): 0 received 0 claimed I TOTAL REIMBURSEMENT REQUEST (3.80). (3.b.). (J.c): .................... I SECTION V. REIMBURSEMENT CLAIM SUMMARY I TNRCC APPUCA'DON FOR REIMBURSEMENT E-Z FORM 12 TNRCC-0230-EZ (Revised09-O1-9S)