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<br />I ! SECTJON Y. REIMBURSEMENT CLAIM SUMMARY ~r;(C
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<br />¡ Please check the appropriate Reimbursement Activity Summary Cost Sheet boxes you have completed for this application for reimbursemenL
<br />Provide the subtotal cost for each Cost Sheet (Schedule A) submitted. Please see the back of Scheàule A (Reimbursement Activity Summary
<br />, Cost Sheet) for additional instructions.
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<br />; 0 -TIVITY - 00: TANK REMOVAL. . . . . . . . . . .. . . . . . . . . . .. . . . . . . . SUBTOTAL $Tf?fFr:';?'%I';fr:',"!m:;;:;r:',,::;:,,':~m:*,',,¡:¡:::::::è:::'
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<br />, 0 ACTIVITY - 01: INITIAL ABATEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . SUBTOTAL $'::::¡:?:::::¡:';::?F'~';:':::::::~'::V~:::::::::::?}:,::,::n;¡:,:,¡:r*:':w.:~'
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<br />. 0 ACTIVITY - 02: PSH REMOVAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SUBTOTAL $:::::t:t::¡':::{'::;:,;f:f¡:r~r~:::'::rtf:m#W~~m@t:*'~":
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<br />0 ACTIVITY - 03: EXCAVATION/WASTE MANAGEMENT. . . . . . . . . . . . . . SUBTOTAL $t:¡?'n::::'~:;rr:'nt}?":':""'J:K,,;m;T::%:~:?::g¡W:$ftF"":;
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<br />1 0 ACTIVITY - 04: SITE ASSESSMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . SUBTOTAL $ ":,,,,:::tn,(:=:?:::f?TF"7?'f:'*,~,,/f:rBn%~,rr:":"
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<br />~ 0 ACTIVITY - 05: RISK ASSESSMENT. . , . . . . . . . . . , . . . . . . . . . . . . . . . SUBTOTAL $:(WW{?'f:7:';f:f:~:=:::;::::";zmf::,r:W~:@i'~~"r;:~:~":'
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<br />, D ACTIVITY - 06: RAP FEASIBILITY TESTING. . . . . . . . . . . . . . . . . . . . . . . SUBTOTAL $W"::::=¡='::;::'f?:;::;:",":;::;::7;':"l.\:,,':,,:Ù'¥-f')""'Ærw,f,%';!',:"'"
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<br />, ~ ACTIVITY - 07: GW MONITORING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . SUBTOTAL $ .:::~::5692:::S:h:¡""?rltf:':':n?fEri?':T?'rc"",:
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<br />1 0 ACTIVITY - 08: REMEDIAL ACTION PLAN PREPARATION. . . . . . . . . . . . . SUBTOTAL $ ;::::;:;::':::::'::n:?I:r;W:'??"':':::T1f1r,,:,:m:'fg::,:::::H,I~~:"
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<br />1 D ACTIVITY - 09: REMEDIATION SYSTEM INSTALLATION. . . . . . . . . . . . . SUBTOTAL $¡::t:::t';:;:::r;::t::{;:::;:t;rw::tt::;::,;:~t{¥?,:;:"iWt¡;;t="::f":::::",,:
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<br />I ~ A:::::: ::::::::::END,MAINTENANCE,:::,': ,':':::::::, :~:::::~ :=:::=:
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<br />. TOTALAMOUNTREOUESTEDINTHISAPPLICATION .............. $ 20,785.66
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<br />I nrn.CC APPUCATION FOR REIMBURSE.'"ŒNT E-Z FORI,,! 12
<br />¡ TNRCC-O230-EZ (Revised 09-01-95)
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