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. 13qArJ 18. Is this first request for reimbursement of corrective action expenses incurred in response to this release? No I yes or no a. If yes: I (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 $1 OK I 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: $ -0- II b. If no: (1) Provide the total of all corrective action expenses either previously reimbursed or previously submitted for reimbursement for this I release incident: $ 1,796,951.52 (2) Have any expenses listed on this application for reimbursement been previpusly reimbursed or submitted for reimbursement? No I yes or no 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 I actions performed on or after May 31 , 1989, the expenses of whith are requested to be reimbursed in this application. Subsequently, provide the total of the costs listed on these reimbursement forms: $ N/A I b. If this is the first request for reimbursement of corrective action expenses incurred in response to this release, then subtract either the $10K deductible I or the remaining deductible amount owed (calculated on Une 18.a.2) from the above amount (Une19.a.) and enter here: $ NJA I c. For the corrective action expenses requested to be reimbursed in this appli- cation provide the amount of any private ilisurance reimbursement that has either been received for these expenses or for which a claim will be filed for. I N/A Subsequently, subtract this amount from amount (Une 19.b) and enter below: I TOTAL REIMBURSEMENT REQUEST: $ . .1 S,269.SÖ....<-... ",/"-"".;-,--"""",::,,,,:,-,:.:,:. 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: På¥xh\g!t 6c of