The completed application will include, at a minimum, the following information:
003.01 The identity of the responsible person and the applicant;003.02 A description of the applicant as a responsible person or designated representative;003.03 The location of the release;003.04 The tank facility registration number assigned by the Nebraska State Fire Marshal, if applicable, of the tank from which petroleum was released;003.05 Information regarding insurance payments or settlements related to the release that have been or may be received;003.06 A detailed description of all costs and documentation for all costs incurred and/or paid by the responsible person for the remedial action and/or third-party claim;003.07 An acknowledgment that the responsible person will be responsible for reimbursing the fund for any partial reimbursement if the responsible person does not complete the remedial action as required by the rules and regulations of the department;003.08 A designated representative statement, if applicable, signed by the responsible person and properly certified;003.09 A verification, signed by the applicant and properly certified, attesting that the information contained in the application is true and accurate; and003.10 An acknowledgement that the recipient's accounting records related to the cost submitted may be audited by the Department and that, if such records are not provided, the recipient may be required to reimburse the fund for any payments previously received.200 Neb. Admin. Code, ch. 1, § 003
Amended effective 12/10/2019Amended effective 4/1/2020Amended effective 4/6/2020