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<br /> ""~ or <br /> Reimbursement Activi Summa Cost Sheet <br /> Billing Period' <br /> LPST ID No.: 92680 From: 07/01/95 <br /> Facility Registration No.: 21680 To: 09/30/95 <br /> <br /> ~ ACTIVITY I O¡::eration and Maintenance 11 <br /> <br /> : <br /> II 0, Invoice Invoice Amount <br /> Company Invoice No. Date Amount Requested <br /> , , $ $ <br /> 159465-0 09/26/95. $ 31. 36 $ 31. 36 <br /> 1 E;e:;7nE;..n (\Q I')') lac:: $ ')Q C::ï $ ')0 e::ï <br /> 155624-0 08/04/95 $ 8.36 $ 8.36 <br /> 155542-0 08/03/95 $ 38.43 $ 38.43 <br /> 155539-0 08/0l/gC) $ 14 01 $ 14 nl <br /> 154201-0 07/18/95 $ 9.72 $ 9.72 <br /> 1 ~14c:;q--n n7 /1"Ie:: /('Ie:: $ 11 ~Q $ 11 lq <br /> <br /> $ $ <br /> Breed and Company $ $ <br /> 19360 08/31/95 $ 11. 96 S 11. 96 <br /> 1q1?? n~ /?Ll lac:: $ 111 01"1 S 111 01"1 <br /> , <br /> 17738 07/21/95 $ 73.14 $73.14 <br /> $ S <br /> .lor Quick $ $ <br /> 15909 09/14/95 $ 15. 70 S 15. 70 <br /> 15905 09/08/95 $ 17 .05 S 17.05 <br /> 16100 08/31/95 $ 24.05 $ 24.05 <br /> 16074 n~ /n~ /qc:; $ 4n nE; $ Lln nE; <br /> $ S <br /> $ S <br /> I Total Amount Requested for Activiev .:.................................... I $33R.61 I <br /> <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 REThffiURSEMENT E-Z FORM <br /> Th'RCC-{ 23O-EZ (11-1-94) <br /> (SCHEDULE A) <br />