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71'¡V SECTION V. REfil,fBURSE~fENT CLAIM SUMi\JARY Please check the appropriate Reimbursement Activity Summary Cost Sheet boxes you have completed for this application for reimbursement. Provide the subtotal cost for each Cost Sheet (Schedule A) submitted. Please see the back of Schedule A (Reimbursement Activity Summary Cost Sheet) for additional instructions. 0 ACTIVITY-01:JNITIALABATEMENT ......................... SUB TOT A L $ :::t:r¡t:;w~fmW:tItWf:fif,m';'f¡WwwtIf(HW¡n """"""""""""""""""""""""""""""""""'" - 0 ACTIVITY-02:TANKREMOVAL .,............,...,......... SUBTOTAL $ :::,:::,mW{'?HŒt;:i}N1mrWiW'HMW'fFt'fff' """""""""""""""""""""""""""'"""" D ACTIVITY - 03: EXCAVATION .............................. SUBTOTAL $ t)m@'f'f@":::f,ttt:¡t""t:"rw:ttg:¡:m~mm:r':'fflff 0 ACTIVITY-04:WASTETREATMENT ........................, SUBTOTAL $ 't¡'n\:t::::::rr:::::l:I@~:r::':':'t'rr::::::':rtt:,:::'I:tr,þ::,,:tHl D ACTIVITY - 05: SITE ASSESSMENT .......................... SUB TOT A L $ ,¡:~~t":"~W:ii':):':'i:i¡if)r¡mf)'\t~t¡Mtm):t¡:::ii~¡t?tt:tr~[t,¡ D ACTIVITY-06:RISKASSESSMENT .......................... SUBTOTAL $ ¡f¡i¡":"rr¡'::t::f'ttt:;?;,,:,{;:"rW'i'W::"['mttIwIWt?i'?g 0 ACTIVITY-07:AQUIFERTESTING ........................... S U 8 TOT A L $ :r?it::rrW:)':rr:rrW@Irnt:@::i'i'im;::J:'t:'t'tWf:"f,:::, ~ """""""""""""""""""""""""""""""""'"....... D ACTIVITY - 08: SOIL VAPOR EXTRACTION PILOT TEST. . . . . . . . . . .. SUBTOT AL $ 'i'tt::':;:t:tWtnmtmi£':':tttn@'fmWi81fE'm G3 ACTIVITY - 09: QUARTERLY MONITORING. . . , . . . . . . . . . . . . . . , .. SUB TOT A L $ r:::g:~:ßPR'i:J?g::::::t:t::f{{J::tfm\'t::"::\n:::l:::::In 0 ACTIVITY - 10: REMEDIAL ACTION PLAN PREPARATION. . . , . . . . . .. SUB TOT A L $ giff:::::::::"ffi"::It'ir:::!:::;:,:::::':tm:':'I"tt':i:tttf:IfWN D ACTIVITY - 11: GROUNDWATER EXTRACTION & TREATMENT. . . . . .. SUB TOT A L $ ¡i:Wt"':';m$'\1~¡W"i~~:i;f~rftitw;r;tmft1Ef:lt D ACTIVITY-12:S0ILVAPOREXTRACTION ....,................ SUBTOTAL $ :¡¡ttt:nrIit;tI¡ŒtÆit:W:)E&IŒiN¡:tI}':::::W~\,:¡; """'.............................................. ...... ........ 51 ACTIVITY - 13: OPERATION AND MAINTENANCE ......,......,.. SUBTOTAL $ ,:;1Ai§lj~;i~Ø§f",iii'f::ti'i:iittf;:;r)ri,':ttt;i::::;i'i:;:;,;;: D ACTIVITY-14:SITECLOSURE.............................. SUBTOTAL $ :'tWWr::t:'Wmt:t:{Wf:tm':~mi:WKft:,:":rnfitt:: TOTAL AMOUNT REQUESTED IN THIS APPLICATION ........... $ 20,383.71 WRITE OUT THE TOTAL REIMBURSEMENT REQUESTED AMOUNT: Twenty thousand three hundred eighty three & 71/100-------------------~~A~---------- -- TNRCC APPLICATION FOR REIMBURSEMENT E-Z FORM 14 TNRCC-O230-EZ (11-01-94)