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<br />TEXAS NATURAL RESOURCE ]çr <br />~ CONSERVATION COMMISSION <br />-- - <br />- - <br />- - <br />- -- <br />~~ PETROLEUM STORAGE TANK <br />---¿-: REMEDIA TION FUND <br /> <br />TNRCC APPLICATION FOR REIMBURSEMENT <br />E-Z FornI <br /> <br />Protecting Texas <br />by Reducing and <br />Preventing Pollution <br />ALL BLANKS MUsr BE COMPLETED. If an Item dœs not apply write "NA". L~COMPLETE APPliCATIONS <br />Vt1LL BE RETURNED. Refer to Guidance Manual RG-174 for instructions. <br /> <br /> <br /> <br /> <br />Applicant (Company): City of San Marcos <br /> <br />Contact Person: Frances Placek <br /> <br />Phone: (ill) 393-8010 Fax: (ill) 392-2625 <br /> <br />Mailing Address: 630 East Hopkins Street <br /> <br />(City) San Marcos (State) Tx (ZIP)78666 <br /> <br />Facility Name: <br /> <br />Facility Address: 630 East Hopkins <br /> <br />(City) San Marcos (State) Tx (ZIP)78666 <br /> <br />County: Hays <br /> <br />Leaking Petroleum Storage Tank (LPST) ID No.:92680 <br /> <br />TNRCC UST Facility Registration No.: 21680 <br /> <br />TNRCC UST Owner Registration No.: <br /> <br />Is this the flISt request for reimbursement for this release? No If no, how many previous claims <br /> <br />have been submitted 22 and total costs of all previous claims $ 2.059.484.82 <br /> <br />Total Cost of this Application (Sectioo V) $ 2.903.60 <br /> <br />Total Reimbursement Request (Secùoo!V)$ 2.903.60 <br /> <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 inspector/RPR coordinatOr. <br />(Preapproval documentation must be submitted with this application.) <br /> <br />Submit the original completed Application For Reimbursement including all Schedule A worksheets to: <br />Texas Natura.l ResolU"ce Conservation Commission <br />Reimbursement Section, MC 139 <br />Petroleum Storage Tank: Division <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />(512)239-2001 <br /> <br />Submit one copy of this Application to the appropriate TNRCC Regional Field Office. <br />