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<br />TEXAS NATURAL RESOURCE J,C- <br />~ CONSERVATION COMMISSION <br />- - <br />- - <br />- .- <br />- -- <br />~ PETROLEUM STORAGE TANK <br />-..-:;¡r REMEDIA TION FUND <br /> <br />THRce APPLICATION FOR REIl\1BURSEMENT <br />E-Z FornI <br />Protecting Texas <br /> <br />Pre~~~~~?ut~:: ,'", ..., '."',':..,,:,", "':<,::,c"""~':',';¡At4~'t,';, ':'>.;.,::'.j;/' ',: ..' " '" ,>\;..,...:t;::/:,,':,,'.. " <br />ALL BLANKS MUST BE' COMPl.EŒD; IfaiifïènidOeS Dot apply Write~'NA". ,INCOMPLE1'E ÁPPÙcAi'IÖNS . <br />WILLBERETURNED.Ref~r.~~;~~ht~;~~~[Ol'instrodio~. . ".Z'>;,;i:',:',..,~;;:'~;f.~'" <br /> <br /> <br /> <br />Applicant (Company): Citv of San Marcos <br /> <br />Contact Person: Frances Placek <br /> <br />Phone: Œll) 393-8010 Fax: (512) 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) ill No.:92680 <br /> <br />TNRCC UST Facility Registration No.: 21680 <br /> <br />TNRCC UST Owner Registration No.: <br /> <br />- Is this the [lISt request for reimbursement for this release? No If no, how many previous claims <br /> <br />have been subITÚtted 21 and total costs of all previous claims S 2.037,601.27 <br /> <br />- Total Cost of this Application (Section V) $21,88355 <br /> <br />Total Reimbursement Request (s=ïonN)$21.88355 <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 irispector/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 Nanrral Resource Conservation Commission <br />ReÚDb~mentSection,~C139 <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 />