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<br />.- - -- -q - <br /> <br /> <br />] Rz <br />SECTION IY. TOTAL REJl\.1BURSEMENT REQUEST <br /> <br />] L YES €) Is <hIs w. fin" "qu~, fa, "imb,m~", of oo~~tiv, ~ti= """~~ iooumd io "'po~, to <hIs "I""" io'id~t' <br /> <br /> <br />j a. If yes: ' <br /> <br /> <br />1. Enter the total costs for work performed: <br /> <br />j <br /> <br />. . . .. . . . . . . . . . . . . . . . " . . " '" " . " "'" . . . . . . . . . . . .. s <br /> <br /> <br />ì Please note that costs for work performed prior to September I, 1987 are not reimbursable. For invoices tbat <br />; oYOrlap tlùs ""'e. costs must be separated as to the date work was peñonned and not by mvo;ce - or - <br />paid. <br /> <br /> <br />b. If DO: <br /> <br /> <br />1. How many pævious claims for reimbursement tor this ælease incident have been submitted? <br /> <br /> <br />Fi~htppn (T S) <br /> <br /> <br />Provide the total of all corrective action expenses pæviously submitted for reimburse::ment for this release incident <br />to date: <br />. <br /> <br />.................................................... S2,OO".~~ <br /> <br /> <br />¡1. Hav. auy OX"""", ""too on "'" awli"rion fo, reimlxm~uout hoen previo",!y 'ubmittOO fo, reimburnomaut? I <br />Tf YM. -ôtÿ th~e 0°'" by item and previo", 'ppHO4tioo. I <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />... <br />( <br />r. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />¡ , <br /> <br />; ; <br />T!'i"RCC APPLICATION FOR REIM:Bu"RSE.\'fEl'.'T E-Z FOR.V! 10 : , ' <br />TNRCC.{)23"EZ (Ro."'" 09.{)I.95) j¡ <br />