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<br />SECI'IÒN V. REIl'vffiURSEl\tIENT CLAIM: SUM:M:ARY ~
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<br />Please check the appropriate Reimbursement Activity Summary Cost Sheet boxes you have completed for this appliC4tion for'
<br />reimbursement. Provide the: subtotal cost for each Cost Sheet (Schedule A) submitted. Please see the back of Schedule A ,-
<br />(Reimbursement Activity Summary Cost Sheet) for additional instructions. I
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<br />0 ACTIVITY - 01: INITIAL ABATEMENT. . , . . . . . . . . . . . . . . . . . . . . .. SUBTOTAL $ ;~'¡'\}{#::ff¡?¡l,),:~~f~-¥:t~¡f~i~:'tt¡:¡¡~f:':~:?W)X:f I
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<br />0 ACTIVITY - 02: TANK REMOVAL. . . . . . . . . . . . . . . . . . . . . . . . . . .. SUBTOTAL $ ::f,W¡t:t¡¡~~f~~r¡:f:?W~~JfJ::~~:%:::F~:t¡¡M¥¡W~%1~~::¡!~':'::
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<br />0 ACTIVITY - 03: EXCAVATION. . . . , . . . . . . . . . . . . . . , . . . . . . , . ., SUBTOTAL $ f'r~:'::~r:;:l:Jn:Hrt:'::::},.;::5¡~Ú/i'nt;t¡,:,¡#w.::j¡W:{ I
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<br />0 ACTIVITY - 04: WASTE TREATMENT. . . . . . . . . . . . . . . . . . . . . . . .. SUBTOTAL $ ~¡M:¡¡¡¡tJ¥::~:gt~::::~}¡:~¡~~;:~W:::¡K~ïi1~¡¡¡~JtWf~1WJ*:¡~ I
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<br />0 ACTIVITY - 05: SITE ASSESSMENT. . . . . . . . . . . . . . . . . . . . . . . . .. SUBTOTAL $ ¥Wi:W~~~¡¡í!t!¡~::J@@*'::~fMWHWJi;i~@¡@%@jf~~ -
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<br />0 ACTIVITY - 06: RISK ASSESSMENT. . . . . . . . . . . . . . . . . . . . . . . . .. SUBTOTAL $ ~rWtm':gr~:i::g~B{:m~i11Jmt~'$.@rftl~~~ I
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<br />0 ACTIVITY - 07: AQUIFER TESTING. . . . . . . . . . . . . . . . . . . . . . . . . .. SU8TOT Al $ ~¡::"¡¡:::~'::q~:;;wr~'~~t?X:~¡:'"f~":::::rwp,;t¡::p~p:H:~l~~:~g:¡ --
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<br />0 ACTIVITY 08 SOIL VAPOR EXTRACTION PILOT TEST SUBTOTAL $ «"""""",:':",:':"':""":',',':':"',:',",""",':,':""':ó"".','."".":",:"':',:':.':""'.""""",'x."'.""~"'" J
<br />- : """""", :""Y"",:::':,}:;"{":,",';:,:':':::::::;:'::':";';:"::':':':"~;:::D.;<>'~':::;:;:::'::::'::::;~:;:::':::;:~::::*
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<br />Œ.I ACTIVITY - 09: QUARTERLY MONITORING. . . . . . . . . . . . . . . . . . . .. SUBTOTAL $ {)?/~::/tq:r:;r:::':?:?::?::::::::4}995Aú4¡::::::~ J
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<br />0 ACTIVITY - 10: REMEDIAL ACTION PLAN PREPARATION. . . .. . . . . .. SUBTOTAL $ ;:::::,:;:::':':::;::;:(,?:,::::::';::::::::":::::'::::''-:-;::/::';-::";:','~:::':';:';;':':;:-:':'~-f::-F::':';::;: a
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<br />0 ACTIVITY - 11: GROUNDWATER EXTRACTION & TREATMENT. . . . , ., SUBTOTAL $ ~:~:':::::'::::::?::::::'::::::?:.',"';-.7:'7'~"~"':"~~';'~"é':- --
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<br />0 ACTIVITY-12:S0ILVAPOREXTRACTION ......,........-..... SUBTOTAl$/:::::/';',.',?:( '" ""',,,..,,'
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<br />~ H'H,"",""" H","'13 03731'.' -
<br />l.!] ACTIVITY- 13: OPERATION AND MAINTENANCE................ SUBTOTAL$/:",/:':;;::::;:;;::::t::::::::',":::,::;." r, ,'"..../','
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<br />0 ACTIVITY.14:SITECLOSURE.........,.................... SUBTOTAl$;:"";:;~:::':'~T;;"-""'H""""":":""':'" J
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<br />TOTAL AMOUNT REQUESTED IN THIS APPLICATION. . . . . . . . . .. $ 18,032.35 I
<br />WRITE OUT THE TOTAL REIMBURSEMENT REQUESTED AMOU!'1T: I
<br />Eighteen thousand thirty two and 35/100-------------------------------iYðtt~----------
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<br />T('o{RCC i\Pf'UC:\TfO~ FOR REr~,1H¡rRSEMF:--:T F 7 Fí1R\f 1~ \
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