Laserfiche WebLink
<br /> 5ÝIA. <br /> SECTION 1. APPLICATION <br /> 1. a. Applicant is: (complete applicable blanks) <br /> Corporation, provide Tax ill No.(Texas or Federal Employee ill No.): <br /> Parmership, provide names and social security numbers for all partners: <br /> (name) (SSN) <br /> (name) (SSN) <br /> Individual, provide Social Security No.: <br /> Lending Institution: Date of foreclosure <br /> Other. Municipality <br /> b. Applicant is the: (check all that apply) <br /> X Tank system OVtl1er X Tank system operator <br /> X Facility OVtl1er 0 Land owner <br /> 0 Former owner 0 Former Operator <br /> 0 Lending Institution 0 Insurance Agency <br /> 2. list the Prime Contractor and/or Prime Corrective Action Specialist in the spaces listed below for which corrective action activities were <br /> supervised and directed for the reimbursement billing period of this application: <br /> a. Prime Contractor: N/A <br /> Mailing address: <br /> Phone: <-) . <br /> b. Prime Corrective Action Specialist: N/A <br /> Mailing address: <br /> Phone: C-) <br /> 3. Ust the number of tanks, the size, and the contents of each tank at the facility for which reimbursement is being sought in this application. <br /> If the tanks were removed and/or abandoned, note which ones were removed and/or abandoned and the date(s) they were removed from <br /> service: <br /> Tank Capacity Contents (g¡iÐline. dicg:l. etc.) Remo'iW and/or Abandoned Date Remo'iW <br /> No. (gallons) (indicate which) from Service <br /> 1 3,000 Diesel 1/91 3/89 <br /> 2 3.000 Diesel 1191 3/89 <br /> 3 10 .000 Gasoline 1191 3/89 <br /> 4 10.000 Gasoline 1191 3/89 <br /> 5 <br /> 6 <br /> TNRCC APPLICATION FOR REIMB URSEMENT E-Z FORM 2 <br /> TNRCC-O230-EZ (Revised 09-01-95) <br />