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VAN DE POLx:2094661910 r Mar 21 2013:42 P. 01 <br /> F <br /> State <br /> ''Water Resources Control Foard <br /> Div} £on of Financial M Ptance <br /> 100 •i street•Sac�V m1a,California 95$14 <br /> P.O.Box 44212-Sa+msnto,California•94244-2120 Arnold sehwskmenegger <br /> I.iada S-Adams . (916)341.5912+1'AX -916)341•-5806@ www.watcrboard9.aagDv/ewphome/ustCf Gnvarnar <br /> Sscretaryfar <br /> i <br /> F.rlvafrnsmRntnl Prnmrtinn <br /> VAN DE POL EN`IBRFRISES,INC. I <br /> DAVID A WATER <br /> p O OX 1107 ' <br /> 5TpCKTQN,CA'95201 <br /> LTNbERCfROC3ND STORAGE TANK CLRA FUND(FUND),ggtMHURSEMENT�QIJEST,CLAIM#018342,FOR ; <br /> srm Ai)DRESS:-1093 CHARTSWAY-W,ST CKTON <br /> S i <br /> APPROVED COSTS: We have reviewed and p ocessed your Reimbursement 5 days. Based op thieceived oil s review,werhave <br /> 6 fax the <br /> above-referenced cla3m,':md yoniU be receival your funds m appraxit�nsteiy <br /> abov rete $10,151 to be reimbursable as shown pari the enclosed Reimbursement Request Form. Total approved for payment to <br /> deter <br /> date is$103;402• <br /> DNS X0 ram?, 31 <br /> foal n vment )will be made for less than$10,000,as indicated on page 2 of <br /> AMOUNT* No future reimbursements(excluding�� 1$,Division 3,Title 23 of the Cleanup Fund Regulations. <br /> the Reimbursement Request Instructions and Se ion 2812(c),Chapter <br /> REQ E3IR>+b DQCUME.N'I`A'1'YpN; With yo next Reimbursement Request,enclose copies of all canceled checks for the <br /> invoices listed ori the"Documentation Request". <br /> requires a claimant to certify all casts that hrwe been,or <br /> Sl')ECTAL NOTICE: Section 25299.55 of the a n't and Safety code, with this section <br /> win be,incurred in undertaking corrective acti . ��the past the Cleanup�Irund has allowed claimants to comply <br /> by agreeing rrewit'thundert s ng co eti p£Pa ent,formerly located on a back of the Reimbursement Request(RR)form. <br /> in an e4Tazt to streamline this certifi on process,the Fuad wi�l now utilize a separate Conditions ofFaymellt <br /> However, ro In o r cl rn ens ub ft t en d n ns <br /> Certification form and anew RRo To fos ! <br /> C e o ti atio f b WIN tt t re' h� em t r ues This Certification will remain on e <br /> pace submitted" 1"he Conditions £payment C `fxcatiorl form is also available at www.waterboards.aa govlcwpbomelustcP, 1 <br /> DUE DATE-'You must submit your nextlr a �Re' ur z�semeet equeak h�not been submitted;(3)Casts inrwed o date ( ) <br /> Status of Cjeanup to date;(2)Iteasans(s) y <br /> corrective notion;and(4)Projected date for Butmiffing a reimbursement request. I��L T TO wrrHDRAW <br /> RE�gUMI&MENT�ONIMYTMENT. IMM-WITFIIrI SIX MONTHS, <br /> YOUR L-ETTER OF . <br /> pure Reimbursement Requests must show th cumulative total(total-to-date)of all costs incurred(bring balance forward)as <br /> discussed Ln the ReimbursemeRt quest lustncoons. le ase <br /> or any quastioi>s r latirig to the pending and ineligible costs in the enclosed Payment Summary p <br /> GONTACT pgRgC7N(S): . uestions relating to submission and/or completion of <br /> contact our tec. Cal s ,Abdul Yusufzai at 916)341-5742. For any q lease call <br /> Putizre reirzsbtu:sem requests or assistance` -obtaitiit►g additional forms(Reirizbursemetlt Requests or SP <br /> readslieets),p <br /> me at(916)341- 12 <br /> F <br /> 1?ayme is Cleanup Fund <br /> C's or �Enirax��ne��sl rntect�o�Agency <br /> i <br /> Recycled'Pspsr <br />