Res 1997-089 - Laserfiche WebLink

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351--- sEcrroN lV. TOTAL REIMBURSEMENT REQUEST (continued) 2. The TNRCC has a required owner/operator contribution or "deductible" that must be met before costs can be reimbursed. The required deductible is based: - how many single petroleum 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 detennined to be admirûstratively complete at the TNRCc. An initial deductible is required for each Occurrence (LPST ill Number - the deductible may increase based upon the failure to 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 12123196 CORRECTIVE ACTION PLAN OPERATES IN ACTION PLAN BY TEXAS PRIOR TO 12/23198 12123197 less than 13 tanks; $ 1,000 $ 2,000 $ 4,000 $ 8,000 13 to 99 tanks, inclusive; S 2,500 $ 5,000 $10,000 $20,000 100 to 999 tanks, inclusive; or S 5.000 $10,000 $20,000 " $40,000 1,000 or more tanks. S10,ooo $20,000 $40 ,000 $80,000 If a site bas received a closure letter and bas a subsequent release on or after 9/1/95, the deductible will be $50,000... . a. N ~ of single petroleum storage tanks owned or operated in Texas: Three (3) (Airnort) b. Enter required deductible: ................................................................................. 3. Provide the following information in order to calculate the total reimbursement request for this application: a. From the Reimbursement Oaim Summary (Section V), provide the total cost for corrective action perfonned: ..... ...,............... ........,... ..... ..., ..............,..... ....... ......... $ b. Enter the required deductible amount """"""".,>"""" "" ..'...'. '-... "-"""""Ñ"'"",O'< {Same as line (1.b.)}: ...... ................................ ............ ....... ..... .;~~!;~~!~i'f:1!~~F:~W!~fil~: 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 filed prior t%~ffi~è 7 1990: .................................................................................$<';i:.}r,:,,:,<.. Insurer name: Policy number. As of / / (date), insurance reimbursement has been (check one): 0 received 0 claimed TOTAL REIMBURSEMENT REQUEST (303.) - (3.b.) - (3.c): ..................... i:~1~f~11! TNRCC APPUCATION FOR REIMBURSEMENT E-Z FORM 11 TNRCC.Q230-EZ (Revised 09.Q1-95)