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<br />r <br />\ (p()£ <br />SECTION ll. APPLICATION <br /> <br /> <br />1. Name of Applicant: City of San M3.rcos <br /> <br />Mailing address: 630 East Hòpkins <br />San Ma.rcos 'IX 7~hh6 <br />(City) (Scatc) (ZIP) <br />Contact Person: Ràv Dinqes <br /> <br />Phone: (512) 393-8006 Fax: <.51.2-) ,q? ?6?C; <br /> <br /> <br />a. Applicant is a: (complete applicable blanks) <br />Texas Corporation, provide Texas Tax ID No.: <br />Federal Employer ID No. <br />Corporation outside of Texas, provide Federal Employer ID No. <br />Partnership, provide names and social security numbers for all partners: <br />(name) (SSN) <br />(name) (SSN) <br />Individual, provide Social Security No.: <br />Lending Institution, provide: <br />Date of foreclosure: <br />Other: Municipality { <br /> <br />b. Applicant is the: (check all that apply) <br />IR Tank system owner §{ Tank system operator <br />~ Facility owner 0 Land owner <br />0 Former owner 0 Former Operator <br />0 Lending Institution <br /> <br />2. If the tank system owner or operator, the facility owner, the land owner, the former owner, the former operator, or the <br />lending institution is different than the applicant shown above, then complete the appropriate spaces listed below: <br /> <br />a. Tank system owner: N/A <br />Mailing address: <br />Phone: L-) <br />Dates of ownership: / / to / / <br /> <br />b. Tank system operator: N/A <br />Mailing address: <br />Phone: L-) <br />Dates of operation: / / to / / <br /> <br /> <br />TNRCC APPUCATION FOR REIMBURSEMENT E-Z FORM 3 <br />....,..",rr.m."".-r:;"7' fTTJ11_Od' <br />