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<br /> Reimbursement Activity SummarY Cost Sheet (PQl)Z <br /> Billing Period <br /> LPST ID No.: 92680 From: 07/01/95 <br /> Facility Registration No.: 21680 To: 09/30/95 <br /> ~ ACTIVITY I II <br /> Quarterly t1:Jni taring <br /> <br /> II Invoice Invoice Amount <br /> Company Invoice No. Date Amount. Requested <br /> xas Industrial Waste Control $ $ <br /> 2185 10/04/95 $2,277.30 $2 277.30 <br /> 2171 07/05/95 $2,277.30 $2,277.30 <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $, <br /> { <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> $ $ <br /> S S <br /> S $ <br /> S $ <br /> $ $ <br /> $ $ <br /> $ S <br /> S S <br /> TotalAmountRequestedforActivitY .:.................................... I s4,554.60 <br /> Attach to this Reimbursement Activity Summary Cost Sheet (Schedule A) all appropriate Invoices and Subcontractor Invoices for the <br /> above referenced Activity. <br /> TNRCC APPLICATION FOR REIMBURSEl\.ŒNT E-Z FORM <br /> TNRCC-ð23O-EZ (11-1-94) <br /> (SCHEDULE A) <br />