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<br /> "'1 <br /> Reimbursement Activi Summary Cost Sheet <br /> Billing Period. <br /> LPST ID No.: 92680 From: 07/01/95 <br /> Facility Registration No.: 21680 To: Og¡-:W/qc:; <br /> <br /> ~ ACTIVITY ~ <br /> I Of:eration and Maintenance <br /> <br /> IL Invoice Invoice Amount <br /> Company Invoice No. Date Amount. Requested <br /> Kellv T - $ $ <br /> 30632673 07/31/95 $ 7R6 40 $ 7Rh /I() <br /> 29647567 07/24/95 $ 786.40 $ 786.40 <br /> 28628428 07/17/QC:; $ 75=<h 40 $ 70c:. 11 () <br /> 27622794 07/10/95 $ 471. 84 $ 471.84 <br /> 2hh()l Oh? ()7 /f"\"> /f"\C" $ 70c:. 11 () $70c. Af"\ <br /> $ $ <br /> Radio Shack-Tandv CoYTYìration $ $ <br /> 0120056335000 08/17/95 $ 75.14 $ 7r::, 14 <br /> $ S <br /> San Marcos Utilities $ $ <br /> 033698010 10/08/95 $ 63.67 $ 63.67 <br /> 033704000 10/08/95 $ 41 ~4 $ 4 1 ~L1 <br /> () 09/18/95 S 56.23 S 56.23 <br /> 033704000 "o9/1R/qr::, S 40 ?5=< $ 11() ')0 <br /> '"() 08/17/95 S 120.89 $ 120.89 <br /> 033704000 !OR/17 lac; $« 00 S ?? (")(") <br /> S ' S <br /> $ S <br /> $ S <br /> $ S <br /> Total Amount Requested for Activity .:..............................:.....1 $ 4,048.87 <br /> Attach to this Reimbursement Activity Summary Cost Sheet (Schedule A) all appropriate Invoices and SubCûntractor Invoices for the <br /> above referenced Activity. <br /> TNRCC APPLICATION FOR REThffiURSEMENT E-Z FORJ\{ <br /> TNRCC-O23O-EZ (11-1-94) <br /> (SCHED~E A) <br />