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<br /> ~. øf)'l. <br /> Reimbursement Activity Summarv Cost Sheet <br /> Billing Period' <br /> LPST ID No.: 92680 From: 07/01/95 <br /> Facility Registration No.: 21680 To: Oq 110 Iqt:; <br /> , , <br /> ~ ACTIVITY I II <br /> Cperation and Maintenance <br /> <br /> t Invoice Invoice Amount <br /> Company Invoice No. Date Amount. Requested <br /> [ofmann I s $ $ <br /> 90408 09/26/QI:), $ lÇ;l Ç;() $ 1 hl Ç;() <br /> $ $ <br /> Kinko's $ $ <br /> 039001080680 08/29/95 $ 49.98 $ 49.98 <br /> ()Q()lC:;() 08/10/95 $ 17 .50 $ 17.50 <br /> 039001080105 08/09/95 $ 48.75 $48.75 <br /> 039001079991 08/04/95 $ 17 .50 $ 17 .50 <br /> 039001079800 07/26/% $ 14 t:;o $ 14 SO <br /> $ S <br /> Kellv Terra:::orarv Services S $ <br /> 39712179 10/02/95 $ 786.40 $ 786.40 <br /> YI nq I?t:; lac:; $ 7QÇ; Lln S 7QÇ; Ll() <br /> 37701711 09/18/95 S 786.40 $ 786.40 <br /> ~~r~ A A~r na/ll/ac:; S Ç;?Q l? S Ç;?Q l? <br /> 35638824 09/04/95 S 786.40 S 786.40 <br /> ~L!.h711hn ()Q I?Q lac:; S 7Qc;. /1(') S 7QÇ; An <br /> 33682592 08/21/95 S 786.40 S 786.40 <br /> 32674160 08/14/95 S 786.40 S 786.40 <br /> 31667744 08/07/95 $ 786.40 S 786.40 <br /> 3003l157 08/01/95 S 157.28 S 157.23 <br /> Total Amount Reouested for ActivitY ..'....................................1$7.387.43 <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 FORi\-! <br /> TNRCC~23O-EZ (11-1-94) <br /> (SCHEDULE A) <br />