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"C¡Afj 18. (s this first request for reimbursement of corrective action expenses incurred in response to this release? No yes or no a. (fyes: (1) Complete copies of the attached reimbursement cost forms detailing man- power,equipment, and supply costs for any corrective actions per- formed prior to May 31, 1989 which are to be applied toward the $10K deductible. Subsequently, provide the total of the costs listed on these reimbursement forms: $ -0- (2) If this amount is less than 10K, then subtract this amount from $1 OK , '- to calculate the remaining deductible amount owed and enter here: I $ -0- b. If no: - (1) Provide the total of all corrective action expenses either previously reimbursed or previously submitted for reimbursement for this release incident: $ 1,781,681.72 - (2) Have any expenses listed on this application for reimbursement been previously reimbursed or submitted for reimbursement? No yes or no I 19. Provide the following information in order to calculate the total reimbursement request for this application: I a. Completed copies of the attached reimbursement cost forms detailing manpower, equipment, and supply costs for the corrective actions performed on or after May 31, 1989, the expenses of whibh are I requested to be reimbursed in this application. Subsequently, provide the total of the costs listed on these reimbursement forms: $ N/A 8 b. If this is the first request for reimbursement of corrective action expenses incurred in response to this release, then subtract either the $1 OK deductible II or the remaining deductible amount owed (calculated on Line 18.a.2) from the above amount (Line19.a.) and enter here: $ N/A c. For the corrective action expenses requested to be reimbursed in this appli- 8 cation provide the amount of any private insurance reimbursement that has either been received for these expenses or for which a claim will be filed for: N/A Subsequently, subtract this amount from I amount (Line 19.b) and enter below: I TOTAL REIMBURSEMENT REQUEST: $ 27,865.66 20. Give the following information for all contractors, subcontractors, consultants. I engineering firms, or others who performed corrective actions at this release site. (Attach additional sheets if necessary) I a. Name of individual or firm: Mailing address: I I Contact person: Phone: pate 4 of 6 of xhibit B