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<br />, <br /> <br />33~ <br /> <br />0 Original <br />0 Regional Office <br />Copy <br /> <br /> <br />TEXAS NATURAL RESOURCE <br />~TeX3S CONSERVATION COl\f.MISSION <br /> <br />w ~ and <br />I"\---þlg Ponution <br /> <br /> <br />PETROLEUM STORAGE TANK REMEDIATION FUND <br />APPLICATION FOR REIMBURSEMENT <br />E-Z Form <br /> <br /> <br />AppliCMlt (Company): Ci ty of ~n M;:¡"YlX)S <br />~' Address: 630 East Hopy~ Street <br />~\ . . (City) san MarCOS (5=) Tx (ZIP) 78666 <br />-l Facll1ty Name: <br />~ . <br />Î' Facility Address: 630 East Hopkins street <br />';. (City) <::rIn M;: r"""""~ (Sat<:) Tx i (ZIP) 78666 <br />""! <br />:~ County: Hays' <br />,",.;;-' <br /> <br />,if;, Leaking Petroleum Storage Tank (LPST) ill No.: 92680 <br />TNRCC UST Facility Registration No.: 21680 <br />TNRCC UST Owner Registration No.: <br /> <br />,. t Submit the original completed Application For Reimbursement including all <br />-.J supplementary worksheets to: <br /> <br />:=:Î <br />"¡ <br />, " Texas Natural Resource Conservation Commission <br />..j\ Petroleum Storage Tank Division <br />,,~,.~ P.O. Box 13087 <br />~f7': Austin, Texas 78711-3087 <br />- ~?~\ Attn: Reimbursement Section <br />~,,- <br />. ~'I <br />::}f\: One additional copy of the Application for Reimbursement must be submitted to the <br />~~~ appropriate Texas Natural Resource Conservation Commission Regional Field Office for <br />:>.1 - the Region where the tanks covered by the application are located. Indicate in the box <br />~ above in the right hand corner if this is the original application, or the Regional <br />;i$J. <br />-'~'~ Office copy. <br />Ä <br />-=~- <br />,-",. <br />.~.:;,: <br />';i.t; TNRCC APPUCA TION FOR REIMBURSEMENT E-Z FORM <br />;':~ TNRCC-023O-EZ (11-01-94) <br /> <br />- <br />