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<br />~ ~n <br />Reimbursement Activitv Summary Cost Sheet <br />Billing Period <br />LPST ID No.: 92680 From: 10/01/95 <br />Facility Registration No.: 21680 To: 12/31/95 <br /> <br /> <br /> <br />~ ACTIVITY I QUARrERLY MOI.\1ITORI~T(; II <br /> <br /> <br />It Invoice Invoice Amount <br />COIDDanv Invoice No. Date Amount Requested <br />~..ATIONAL ENVIROt\JrYIENTAL TESTING $ $ <br />56181 12-14-95 $ 500.00 $ 500.00 <br />$ $ <br />TEXAS IÑTIUSTRIAL WASTE CONTROL $ S <br />2195 11-16-gC; $7r1?Q r1? $7r1?Q r1? <br />2185 10-04-95 $ 2277.30 S 2277 .30 <br />$ $ <br />$ $ <br />" <br />$ $ <br />$ $ <br />$ $ <br />$ $ <br />$ S <br />$ S <br />: $ $ <br />$ $ <br />$ $ <br />S $ <br />$ $ <br />$ $ <br />$ $ <br /> <br />I Total Amount Requesred for Activitv ..'....,.............................". 1$ 9.RO5.l? I <br /> <br />Attach to this Reimbursement Activity Summary Cost Sheet (Schedule A) all appropriate Invoices and Subcontractor Invoices for the <br />above referenced Activity. <br /> <br /> <br />TNRCC APPLICATION FOR REL\ffiURSEMENT E-Z FOR.\-! <br />TNRCC-û230-EZ (11-1-9-1) <br /> <br />(SCHEDULE A) <br />