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SECTION 1. APPLICATION (continued) J5fi 4. YES I NO Have all the tanks at this facility been registered with the TNRCC? If yes, provide the facility registration number assigned by the TNRCC: 21680 If no, please note that after December 31, 1995 all USTs and ASTs must be registered with the 1NRCC to be eligible for reimbursement (Refer to Guidance Manual for more information.) Also, note that tank registration fees must be paid before the reimbursement check can be released. 5. YES I NO Have the tank owner(s) and/or operator(s) registered with the 1NRCC a.!l ~ tank systems in Texas which they knowingly own or operate? 6. YES I NO Have the tank owner(s) and/or operatcc(s) paid in full all arumal tank registration fees due since September 1, 1987 for all tanks which they own or operate? If no, please note that all outstanding fees must be paid in full before the reimbursement check can be released. 7. YES IN 0 Does the application contain acceptable evidence of proof of payment for all claimed expenses. Evidence of acceptable proof of payment may include the following items: . Business receipts or invoices from the person who performed the work, indicating payments received; . Canceled checks (copies, front and back); . An affidavit signed by the person who performed the work affirming that the amounts which the applicant representS as being paid to him were paid in full. If the contractor has accepted a promissory note as "payment", a copy of the Promissory Note must be submitted with the affidavit; or . 'I"œ certification of a certified public accountant that the expenses for which reimbursement is requested have been paid in full. 8. YES I NO Have you assigned your reimburserrent payment? If yes, please complete the Notice of Assignment and Assignment Contract found in the Appendix in the Reimbursement from the Petroleum Storage Tank Remediation Fund Guidance Manua!. Please -- see page 13 in the Guidance Manual and refer to §334.302 (i), 0), and (k)(1)(2) to see if the assignment is valid. 9. YES. I NO All of the petroleum storage tanks that are subject to registration requirements are registered with the 1NRCC and all annual tank registration fees due since September 1,1987, have been paid in full. (Please note that all fees owed must be paid in full prior to the disbursement of the reimbursement check.) 10. YES I NO Have new tanks been installed at this site? If yes, when: _1_1_. 11. YES 1.riQ Have any upgrade or new installation activity costs been included in the total reimbursement request listed on line 3, page 13 of this application? TNRCC APPLICATION FOR REIMBURSE.J.,íENT E.Z FORM 3 TNRCC-O230-EZ (Revised 09-01-95)