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I 735 1 Mailing address: N/A . Phone: <-) I 5. List the number of tanks, the size, and the contents of each tank at the facility for which reimbursement is being sought I ~ this application. If the tanks were removed and/or abandoned note which ones were removed and/or abandoned and the date(s) they were removed from service: I I Tank No. Capacity (gallons) Contents (gasoline. diesel, etC.) Removed and/or Date Removed Abandoned from Serviu I (indicate which) 1 3000 Diesel 1/91 3/89 I 2 3000 Diesel 1/91 3/89 I 3 10,000 Gasoline 1/91 3/89 4 10,000 Gasoline 1/91 3/89 I 5 8 6 i 7 I 8 t. 9 10 , 11 I 12 1 6. @)/NO Have the tanks from which the release occurred been registered with the TNRCC? If yes, provide the facility registration number assigned by the TNRCC: I If no, please note that all tanks that are subject to the registration requirements must be registered and tank registration fees paid before the reimbursement check can be released. 7. @)¡ NO Have the tank owner(s) and/or operator(s) registered with the TNRCC all other tank systems in I Texas which they knowingly own or operate? 8. @-NO Have the tank owner(s) and/or operator(s) paid in full all annual tank registration fees due since September 1, 1987 for all tanks which they own or operate? IT no, please note that all outstanding fees must be paid in full before the reimbursement check can be released. TNRCC APPUCATION FOR REIMBURSEMENT E-Z FORM 5 'n..n>rrJY1~{)"F7 f1 T -01-94)