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How to complete the Reimbursement Activity Summary Cost Sheet 73,/£ Schedule A 1. Fill in the Leaking Petroleum Storage Tank (LPST) identification number and facility registration number in the specified blanks, 2. Complete the billing period dates. This provides the TNRCC with the time period for the work performed at your facility. . 3, One Reimbursement Activity Summary Cost Sheet (Schedule A) should be completed for each activity (Listed on page 14) for which you are seeking reimbursement. For example, if you are requestin2: reimbursement for a tank removal, excavation, and a site assessment, then one form for each of thl activities must be submitted (i,e. one form for the tank removal costs, one form for excavation costs, <: one form for the site assessment costs). 4. For each Summary Cost Sheet (Schedule A), list the invoices for which you are seeking reimbursement. Detail the following: Company performing work, their invoice number, invoice date, total invoice amount, and the amount you are requesting from that invoice for the activity. One invoice may contain costs for more than one activity, meaning the same invoice may be listed on more than one activity sheet within the reimbursement claim. When this occurs, only request those costs from that invoice specific to that activity. 5. To each Summary Cost Sheet (Schedule A), attach the appropriate invoices, subcontractor invoices, pre- approval information, and proof of payment. < TNRCC APPLICATION FOR REThffiURSEMEr-.. E-Z FORM TNRCC-o230-EZ (11-1-94) (SCHEDULE A)