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<br /> ~, 731ft) <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 II <br /> I OPERATION AND MAINI'ENANCE <br /> <br /> -- Invoice Invoice Amount <br /> Company Invoice No. Date Amount Requested <br /> . - L MARl' STORES, INC $ $ <br /> 4869604 11-27-95 $ 14.91 $ 14.91 <br /> 3570627 10-12-QC; $ 1 Q ':1.7 $ 1 Q ':1.7 <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> ~ <br /> S $ <br /> $ $ <br /> $ S <br /> $ S <br /> S S <br /> $ S <br /> S S <br /> $ S <br /> S S <br /> S S <br /> S S <br /> S $ <br /> S S <br /> Total Amount Requested for Activiev .:....................................1 $ 33.28 <br /> Attach to this Reimbursement Activity Summary Cost Sheet (Schedule A) all appropriate Invoices and Subcontractor Invoices for the <br /> above referenced Acti viry. <br /> TNRCC APPLICATION FOR REߌURSEMENT E-Z FORM <br /> TNRCC-O230-EZ (11-1-94) <br /> (SCHEDULE A) <br />