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Nelson Ready Mix Concrete And Rock Company, Inc. -2- <br /> Claim No. 019076 <br /> reasonable, necessary, and cost effective method for your corrective action. Only <br /> corrective action costs required by the regulatory agency to protect human health, <br /> safety and the environment can be claimed for reimbursement. <br /> The following documents must be submitted when seeking reimbursement. The Fund <br /> will not reimburse costs incurred prior to January 1, 1988: <br /> 1. The Conditions of Payment Certification form. This form must be submitted <br /> with your first reimbursement request. <br /> 2. A Reimbursement Request Form (enclosed). Two copies of this form have <br /> been enclosed for your use in this packet. Instructions for filling out the <br /> Reimbursement Request form can be found on the back of the form. <br /> 3. A Reimbursement Request Spreadsheet. This form is used to organize and <br /> track corrective action costs incurred. . After completion, this spreadsheet must be <br /> printed and submitted with your reimbursement request. Additionally, you must <br /> submit the completed spreadsheet electronically to the Fund. <br /> The Conditions of Payment Certification form and Reimbursement Request spreadsheet <br /> can be found on the Fund's website at <br /> http://www.waterboards.ca.gov/water issues/programs/ustcf/forms.shtml. <br /> a, THIS IS IMPORTANT TO YOU, PLEASE NOTE: <br /> Signature(s) on the application will be the signature(s) required for all future Fund <br /> documents. <br /> We encourage claimants to sign all Fund documents personally. However, there may <br /> be circumstances where a claimant wants a representative to be able to sign Fund <br /> documents on the claimant's behalf. In this situation, claimants must submit a notarized <br /> Power of Attorney form designating a specific representative to sign and submit <br /> documents to the Fund. The designated representative should not be a consultant or <br /> contractor performing work on the project site because it would create a conflict of <br /> interest. Claimants should be aware that they are personally responsible and bound by <br /> any assertions made to the Fund pursuant to a Power of Attorney. (An appropriate <br /> Power of Attorney form is available on our web site or by request, however other forms <br /> may also be acceptable.) <br /> If the site is closed: Claimants have 365 days from the date of the site closure letter or <br /> from the date of this LOC, whichever occurs later, to submit cleanup costs to the Fund <br /> for reimbursement. All remediation costs, including monitoring well destruction and <br /> abandonment costs and case closure costs, must be submitted to the Fund prior to the <br /> 365-day deadline. The Fund will not reopen your claim or reimburse costs submitted <br /> after the deadline. <br />