Res 1993-092 - Laserfiche WebLink

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I \jD'ff 18. (5 this first request for reimbursement of corrective action expenses incurred in response to this release? No , yes or no a. If yes: J (1) Complete copies of the attached reimbursement cost forms detailing man- power, equipment, and supply costs for any corrective actions per- formed p':Ï°r to May 31, 1989 which are to be applied toward the $1 OK deductible. Subsequently, provide the total of the costs listed I I on these reimbursement forms: $ -0- I If this amount is less than 10K, then subtract this amount from $1 OK I (2) to caJculate the remaining deductible amount owed and enter here: I $ -0- I 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: $ 1,781,681.72 , I (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 which are I 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 or the remaining deductible amount owed (calculated on Une 18.a.2) from the above amount (Une19.a.) and enter here: $ N/A 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 claim will be filed for: N/A Subsequently, subtract this amount from amount (Une 19.b) and enter below: TOTAL REIMBURSEMENT REQUEST: $ 27,865.66 20. Give the following information for all contractors, subcontractors. consultants, engineering firms, or others who performed corrective actions at this release site. (Attach additional sheets if necessary) a. Name of individual or firm: Mailing address: , Contact person: Phone: pa1:;e 4 of 6 of xhibit B