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<br /> ..., 73>(" <br /> Reimbursement Activity 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 /> ~ ACTIVITY I Operation and Maintenance II <br /> <br /> <br /> IL Invoice Invoice Amount <br /> Company Invoice No. Date Amount Requested <br /> LDVANCED BUSINESS SYSTENS $ $ <br /> 161645-0 10-24-95 $ 21.17 $ 21.17 <br /> -n 1 n..n<, _a~ $ a 7') S 9.72 <br /> $ $ <br /> BREED Ai\ID $ S <br /> <br /> 23240 12-19-95 $ 6.45 S h 4C:; <br /> ')<')<1 1')_1 a_-oe: $ ~~ ¡:;4 $ ~~ 114 <br /> 22977 12-12-95 $ 6.88 S' 6.88 <br /> . <br /> 21962 11-13-95 $ 65.34 $ 65.34 <br /> $ $ <br /> COLOR QUICK S $ <br /> 15927 10-17-QC:; $ 7 ~n $ 7 ~n <br /> 15926 10-13-95 $ 22.00 $ 22.00 <br /> ! lC:;Q?~ In-ln-or; $ 1 1 c;n $ 11 c:n <br /> I 15920 10-06-95 S 11. 50 $ 11.50 <br /> $ S <br /> G . A . POWERS c:Q;1P Ai"\JY $ S <br /> 27530 12-12-95 S 57 . 55 S 57. 55 <br /> S S <br /> f-- S S <br /> S S <br /> TotaIAmountRequestedforActîvity .:.................................... 1$ 253.05 <br /> Attach to this Reimbursement Activity Summary Cost Sheet (Schedule A) all appropriate Invoices and Subcontractor Invoices for the <br /> above referenced Activity. <br /> TNRCC APPLICATION FOR REL\.ŒURSEMENT E-Z FORM <br /> TNRCC-Û230-EZ (11-1-9-1) <br /> (SCHEDULE A) <br />