Res 1998-049 - Laserfiche WebLink

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SECfION IV. TOTAL REIMBURSEMENT REQUEST (continued) 2. 1be 1NRCC ha" a required owner/operator contribution or "deductible" that must be met before costs can be reimbursed. The required deductible is based: . how many single pen-oleum storage tanks the applicant owns or operates in Texas: . if specific corrective action milestones are met; and . the number of occurrences when the application is determined to be administratively complete at the TNRCC. AD iDitial deductible is required for each Occurrence (LPST ID Number - the deductible may increase based upon the failure 80 meet specific corrective action milestones). The deductible, or "owner/operator contribution" will be as follows: . NUMBER OF REQUIRED FAILURE TO FAILURE TO FAILURE TO SINGLE DEDUCTIBLE SUBMIT A SUBMIT MEET PETROLEUM ($) SITE AND RECEIVE THE GOALS IN STORAGE TANKS ASSESSMENT APPROVAL THE APPROVED APPLICANT OWNS PRIOR TO FOR CORRECTIVE OR 12/23/96 CORRECTIVE ACTION PIAN OPERATES IN ACTION PLAN BY TEXAS PRIOR TO 12I23J98 12J231fJ7 less than 13 tanks; $ 1,000 $ 2,000 $ 4,000 $ 8.000 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 1.000 or more tanks. $10.000 $20.000 $40.000 $80,000 If a site has received a closure letter and bas a subsequent release on or after 9/1195. the deductible will be $50,000. a. Number of single petroleum storage tanks owned or operated in Texas: Three (3) (AiQ)OrO b. Enter required deductible: . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. NIA 3. Provide the following information in order to calculate the total reimbursement request for this application: a. From the Reimbursement Claim Summary (Section V), provide the total cost for corrective action ~onned: """"""""""'" -.. """ """""""""""""""""""'" ....$ b. Enter the required deductible amount {SaIIle as line (1.b.)}: ........................................................... $ N/A c. For the corrective action expenses requested to be reimbursed in this application, provide the amount of any private insurance reimbursement that bas already been received for these expenses or for which a claim was med prior to July 17. 199Q:u ..., .. ...... ... ... .. . . -............ ........ "'" """ . .. ... .. ........ ""'" $ Insurer name: Policy number: As of I / (date), insurance reimbursement has been (check one): 0 received Dclaimed TOTAL REIMBURSEMENT REQUEST (3.a.) - (3.b.) - (3.e): .................... SECTION V. REIMBURSEMENT CLAIM SUMMARY TNRCC APPUCA -nON FOR REIMBURSEMENT E-Z FORM 12 TNRCC-0230-EZ (Revised 09-01-95)