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<br /> How to complete the Reimbursement Activity Summary Cost Sheet 73'( <br /> Schedule A <br /> 1. Fill in the Leaking Petroleum Storage Tank (LPST) identification number and facility registration number <br /> in the specified blanks. <br /> 2. Complete the billing period dates. This provides the TNRCC with L~e time period for the work performed <br /> at your facility. . <br /> 3, One Reimbursement Activity Summary Cost Sheet (Schedule A) should be completed for each activity <br /> (Listed on page 14) for which you are seeking reimbursement. For example, if you are requesting <br /> reimbursement for a tank removal, excavation, and a site assessment, then one form for each of th, <br /> activities must be submitted (i,e. one form for the tank removal costs, one form for excavation costs, c <br /> one form for the site assessment costs), <br /> 4. For each Summary Cost Sheet (Schedule A), list the invoices for which you are seeking reimbursement. <br /> Detail the following: Company performing work, their invoice number, invoice date, total invoice amount, <br /> and the amount you are requesting from that invoice for the activity. <br /> One invoice may contain costs for more than one activity, meaning the same invoice may be listed on more <br /> than one activity sheet within the reimbursement claim. When this occurs, only request those costs from <br /> that invoice specific to that activity. <br /> 5. To each Summary Cost Sheet (Schedule A), attach the appropriate invoices, subcontractor invoices, pre- <br /> approval information, and proof of payment. <br /> ~ <br /> TNRCC APPLICATION FOR REßffitiRSEME1'<'T E-Z FOR.1\.1 <br /> TNRCC.{}230-EZ (11-1-94) <br /> (SCHEDULE A) <br />