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<br /> 3J)ß <br /> - <br /> SECTION IV. TOTAL REI1HBURSEMENT REQUEST (continued) <br /> 2. The TNRCC has a required owner/operator contribution or "deductible" that must be met before costS can be reimbursed. The required <br /> deductible is based: <br /> . how many single petroleum storage tanks the applicant owns or operates in Texas; <br /> . if specific corrective action milestones are met; and <br /> . the number of occurrences when the application is determined to be administratively complete at the TNRCc. <br /> An initial deductible is required for each Occurrenœ (LPST ID Number - the deductible may increase based upon the failure to <br /> meet specific corrective action milestones). The deductible. or flowner/operator contributionfl will be as, follows: <br /> NUMBER OF REQUIRED FAILURE TO FAILURE TO F AlLURE TO <br /> SINGLE DEDUCTIBLE SUBMIT A SUBMIT MEET <br /> PETROLEUM ($) SITE AND RECEIVE THE GOALS IN <br /> STORAGE TANKS ASSESSMENT APPROVAL THE APPROVED <br /> APPLICANT OWNS PRIOR TO FOR CORRECTIVE <br /> OR 12123196 CORRECTIVE ACTION PLAN <br /> OPERATES IN ACTION PLAN. BY <br /> TEXAS PRIOR TO 12123198 <br /> 12123197 <br /> less than 13 tanks; $ 1,000 $ 2,000 $ 4,000 $ 8,000 <br /> 13 to 99 tanks, inclusive; $ 2.500 $ 5.000 $10.000 $20,000 <br /> 100 to 999 tanks. inclusive; or $ 5.000 $10,000 $20,000 $40,000 <br /> 1 ,000 or more tanks. $10,000 $20.000 $40.000 $80,000 <br /> If a site has received a closure letter and has a subsequent release 00 or after 9/1/95. the deductible will be $50.000. <br /> . <br /> a. N wnber of single petroleum storage tanks owned or operated in Texas: Three (3) ( Airoort) <br /> <br /> b. En.~ :~~~ .œd.~rib~' . . .. . .. . . .. . .. . . . . . .. . .. . .. .. . .. . .. .. .. . . . . . . . . .. . .. .. .. .. . ~pwW-~ <br /> <br /> 3. Provide the following information in order to calculate the total reimbursement request for this application: <br /> a. From the Reimbursement Claim Summary (Section V), provide the total cost for corrective action perf~;""""~"""""~""",^""~"",-,,,,,,),, ".v" <br /> I ................................................................................. ~'è';'{;~';~!~~'tf~5~fjiæt:~;,~.':' <br /> ¡ <br /> ! b. Enter the required deductible amount ;;t^ '=¡Jji51:~::~7"~J~"t~Jif~;;:" ,"" <br /> {Same as line (l.b.)}: ...............................................................$ 'NfA" <br /> <br /> c. For the corrective action expenses requested to be reimbursed in this application, provide the amount of any private insurance <br /> reimbursement that has already been received for these expenses or for which a claim was filed prior to July} J"L?,?9:,,;-;, ,;"., <br /> ................................................................................. $',_vv<\:.:;:;i,f~'71~: <br /> Insurer name: <br /> Policy number. <br /> <br /> As of / / (date), insurance reimbursement has been (check one): 0 received 0 claimed <br /> <br /> I TOTAL REIMBURSEMENT REQUEST (3.a.) - (3.b.) - (3.c): ..................... b ,,;, H' I <br /> 2~903.60' . <br /> <br /> TNRCC APPUCATION FOR REIMBURSEMENT E-Z FORM 11 <br /> TNRCC-D230-EZ ~vised 09-D1-95) <br />