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<br />3Jß <br /> <br />. <br /> <br />- -- <br />~ - O"al <br />= .: 0 ngm <br />:" ~ 0 Regional Office <br />.~ Copy <br />a--i1 <br />THRCC TEXAS NATURAL RESOURCE <br />Prot~tingTexas CONSERVATION COl\fMISSION <br /> <br />: I Reducing and <br />I 3nting pollt.rtion <br /> <br /> <br />PETROLEUM STORAGE TANK RE:MEDIATION FUND <br />APPLICATION FOR REIl\1BURSE:MENT <br />E-Z Form <br /> <br />! . . <br /> <br />Applicant (Company): Ci t Y 0 f San Ma r co s <br /> <br />Address: 630 East Hopkins Street <br /> <br />(City) San Marcos (S=) Tx (ZIP) 7Róóó <br />Facility Name: J <br /> <br />! Facility Address: 630 East Hopkins Street <br /> <br />! (City) San Marcos (Stale) Tx (ZIP) 78666 <br />County: Hays <br /> <br />! Leaking Petroleum Storage Tank (LPST) ill No.: 92680 <br /> <br />TNRCC UST Facility Registration No.: 21680 <br /> <br />I TNRCC UST Owner Registration No.: <br /> <br /> <br />Submit the original completed Application For Reimbursement including all <br />supplementary worksheets to: <br /> <br /> <br />Texas Natural Resource Conservation Commission <br />Petroleum Storage Tank Division <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />Attn: Reimbursement Section <br /> <br />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 />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 />Office copy. <br /> <br /> <br /> <br />TNRCC APPLICATION FOR REIMBURSEMENT E-Z FORM <br />-.. -- .. -. ~.. <br />