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<br /> SECTION I. APPLICATION <br /> 1. a. Applicant is: (complete applicable blanks) <br /> Corporation. provide Tax ID No.(Texas or Federal Employee ID No.): <br /> Partnership, provide names and social security numbers for all partners: <br /> (name) (SSN) <br /> (name) (SSN) <br /> Individual. provide Social Security No.: <br /> Lending Iostituûon: Date of foreclosure <br /> Other: Munidpali" <br /> b. Applicant is the: (check all that apply) <br /> X Tank system owner X Tank system operator <br /> X Facility owner 0 Land owner <br /> 0 Former owner 0 Former Operator <br /> 0 Lending Institution 0 Insmance Agency <br /> 2. list the Prime Contractor and/or Prime Com:ctive Action Specialist in the spaces listed below for which coITeCtive action activities were <br /> supervised and directed for the œimbulsement billing period of tbis application: <br /> a. Prime Contractor: N/A <br /> Mailing address: <br /> Phone: <---J <br /> b. Prime CoITeCtive Action Specialist: N/A <br /> Mailing address: <br /> Phone: <---J <br /> 3. List the number of tanks, the size, and the contents of each tank at the facility for which reimbursement is being sought in this <br /> application. If the tanks were removed andJor abandoned, note which ones were removed and/or abandoned and the date(s) they were <br /> removed from service: <br /> Tank CapllCity Cootents (gasoline, diesel. eIC.) RemIved andIŒ Abandœed Date ReIooved <br /> No. (gallons) (indicate which) from Service <br /> 1 3,000 Diesel 1/91 3/89 <br /> 2 3,000 Diesel 1/91 3/89 <br /> 3 10 ,000 Gasoline 1/91 3/89 <br /> 4 10,000 Gasoline 1/91 3/89 <br /> 5 <br /> 6 <br /> 11IIRCC APPUCA -nON FOR REIMBURSEMENT E-Z FORM 3 <br /> TNRCC-û230-EZ (Revised 09-01-95) <br />