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<br />- 3SAft <br />SECTION IV. TOTAL REIMBURSEMENT REQUEST <br /> <br />1. YES I NO Is this the first request for reimbursement of corrective action expenses incurred in response to this release incident? <br /> <br /> <br />a. If yes: <br /> <br /> <br />i. Enter the total costs for work perfonned: <br /> <br /> <br /> <br />.. ............. ................................ """""'" ...... $"" <br /> <br /> <br />Ptease note that costs for work performed prior to September 1, 1987 are not reimbursable. For invokes that <br />overlap this date, costs must be separated as to the date work was performed and not by invoice date or date <br />paid. <br /> <br /> <br />b. If no: <br /> <br /> <br />i. How many previous claims for reimbursement for this release incident have been submitted? <br /> <br />Twenty-two (22) <br /> <br />Provide the total of all corrective action expenses previously submitted for reimbursement for this release incident <br />to date: <br /> <br /> <br /> <br />. . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . : - . .. . . "$;;:.." .'O"",hO'"h <br /> <br /> <br />Ü. Have any expenses listed on this application for reimbursement been previously submitted for reimbursement? If <br />yes, identify these costs by item and previous application: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />TNRCC APPUCATION FOR REIMBURSEMEln E-Z FOR-\-{ 10 <br />TNRCC-D230-EZ (Revised 09-D1-95) <br />