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í 18. Is this flrst request tor reimbursement of corrective action expenses incurred I Y 0 ¡J in response to this release? No I yes or no a. If yes: (1) Complete copies of the attached reimbursement cost forms detailing man~ I 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 deductible. Subsequently. provide the total of the costs listed í on these reimbursement forms: $ - 0 - I (2) If this amount is less than 10K, then subtract this amount from $10K to calculate the remaining deductible amount owed and enter here: I $ -0- -- b. If no: I I (1) Provide the total of all corrective action expenses either previously reimbursed or previously submitted for reimbursement for this release incident: $ 1.796.951.52 I (2) Have any expenses listed on this application for reimbursement been previo.usly reimbursed or submitted for reimbursement? No yes or no i 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 which are I requested to be reimbursed in this application. Subsequently. provide the total of the costs listed on these reimbursement forms: $ NJA I b. If this is the first request for reimbursement of corr~e action expenses incurred in response to this release. then subtract either the $1 OK 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 insurance reimbursement that has either been received for these expenses or for which a cjæm will be filed for. I N/A Subsequently. subtract this amount from amount (Une 19.b) and enter below: I I TOTAL REIMBURSEMENT REQUEST: $ 15.269~8Õ ................ . 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) l a. Name of individual or firm: Mailing address: I I Contact person: Phone: Pà¥xh'1bOtt 6c of .,