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<br /> TEXAS NATURAL RESOURCE 65 <br /> ,., CONSERV A TION COM MISSION <br /> - - <br /> - -- <br /> . PETROLEUM STORAGE TANK <br /> REMEDIA TION FUND <br /> TNRCC APPLICATION FOR REIMBURSEMENT <br /> E-Z Form <br /> Protecting Texas <br /> by Reducing and <br /> Preventing PoItutíon <br /> ALL BLANKS MUST BE COMPLETED. If anite.. doesJlOt appIJ write "NA". INCOMPLETE Al'PLICA 'nONS <br /> WI1J.. BE RETURNED. Rdet"toGuidanee.u..JRGrr4rør inItructfoas. <br /> Applicant (Company): City of San Marcos <br /> Contact Person: Frances Plocek <br /> Phone: (ill) 393-8010 Fax: (ill) 392-2625 <br /> Mailing Address: 630 East Hopkins Street <br /> (City) San Marcos (State) Tx (ZIP)78666 <br /> Facility Name: <br /> Facility Address: 630 East Hopkins <br /> (City) San Marcos (State) Tx (ZIP)78666 <br /> County: Hays <br /> Leaking Petroleum Storage Tank (lPST) ID No.:92680 <br /> TNRCC UST Facility Registration No.: 21680 <br /> TNRCC UST Owner Registration No.: <br /> Is this the first request for reimbursement for this release? No If no, how many previous <br /> claims have been submitted 25 and total costs of all previous claims $ 2,084.280.27 <br /> Total Cost of this Application (Section V) $ 11,338.95 <br /> Total Reimbursement Request (SecliĊ“lV)$ 11,338.95 <br /> Number of single petroleum storage tanks owned or operated in Texas: 3 <br /> <br /> 0 Check here if the TNRCC has preapproved the work described in this application. The TNRCC will <br /> reimburse only those costs that have been preapproved by the region inspectorlRPR coordinator. <br /> (Preapproval documentation must be submitted with this application.) <br /> Submit the original completed Application For Reimbursement including all Schedule A worksheets to: <br /> Texas Natural Resource Conservation Commissìon <br /> Reìmbursement Section, MC 139 <br /> Petroleum Storage Tank Dìvisìoo <br /> P.O. Box 13087 <br /> Austin, Texas 78711-3087 <br /> (512)239-200 1 <br /> Submit one copy of this Application to the appropriate TNRCC Regional Field Office. <br />