(2) CONTENTS OF APPLICATIONS. An owner or operator who seeks reimbursement of response action costs shall complete and submit to the department all the following: (a) An application form containing all the following: Note: Forms are available at no charge from the remediation and redevelopment program in any department regional or central office or by contacting the department at (608) 266-2111.
1. The owner or operator's name and address and a statement indicating how the applicant qualifies as an owner or operator under s. NR 169.07.2. If an agent of the owner or operator is directing the response action, the name, address and phone number of the agent and a dated copy of the agency agreement.3. A statement indicating whether the owner or operator has applied or will apply to another department program or another government agency for reimbursement of response action costs incurred for the same facility.4. Information regarding multiple owner or operators including: a. Names, addresses and phone numbers of all co-owners and all co-operators.b. A certification that the owner or operator has made a reasonable effort to notify other owners or operators.5. Dry cleaner facility information including information on whether the facility is still operating or operable, pollution prevention measures implemented and information on the construction of the facility.6. Discharge information associated with the facility.7. Consultant information, including the contact name and business name.8. Insurance information, including a statement indicating whether any portion of the response action costs for which the owner or operator seeks reimbursement may be covered by insurance, or a statement from the owner's or operator's insurance company stating that the insurance company has denied the owner's or operator's claim for reimbursement of the response action costs9. Other relevant information requested by the department.(b) A reimbursement cost summary form containing all the following: Note: Forms are available at no charge from the remediation and redevelopment program in any department regional or central office or by contacting the department at (608) 266-2111.
1. The total eligible response action costs for which the owner or operator seeks reimbursement from the department and a breakdown of those costs into the categories listed in par. (e).2. Other relevant information requested by the department.(c) A map showing the town, range, section and quarter-quarter section location of the facility.(d) An accurate legal description of the land parcel where the facility is located which corresponds to the most recent accurate parcel description filed with the register of deeds in the county where the land parcel is located.(e) A cost detail worksheet form which lists and identifies each eligible response action cost for which the applicant seeks reimbursement from the department, indicates whether the response action cost was for an immediate action, interim remedial action, site investigation or remedial action, and allocates cost to one of the following categories: Note: Forms are available at no charge from the remediation and redevelopment program in any department regional or central office or by contacting the department at (608) 266-2111.
3. Groundwater investigation.4. Groundwater remediation.5. Air/vapor investigation.6. Air/vapor remediation.7. Laboratory and other analysis.8. Miscellaneous. Note: Section 292.65(8) (j), Stats., provides that if any person applies for reimbursement of an ineligible cost, the department may deduct 50% of the amount of that cost from that person's eligible reimbursement claim. An owner or operator who is not certain whether a cost is eligible for reimbursement under this chapter may contact the department for a preliminary opinion under s. NR 169.19(1).
(f) Invoices or other information documenting and cross referencing each of the costs listed under par. (e) and identifying the nature of the materials or services provided, the amount charged for the materials or services, the identity of the provider, and the dates on which the materials or services were provided(g) Canceled checks or other information documenting that the applicant has paid all of the costs under par. (e), and cross referenced to the statement provided under par. (e).(h) For each cost listed under par. (e), a copy of the accepted bid proposal as well as a cumulative listing of all change orders to the original bid proposal approved to date.(i) A spreadsheet that identifies and cross references each cost in par. (e) with the documentation under pars. (f) and (g) supporting that cost.(j) A substitute W-9 tax form completed by the owner or operator applying for reimbursement. Note: Reimbursement paid to an owner or operator under this chapter may be reported as taxable income received by that person.
(k) Other relevant information required by the department. Note: Contact the Department of Natural Resources, Bureau for Remediation and Redevelopment, P.O. Box 7921, Madison, WI 53707, for free application materials, including illustrative examples and the forms required under this section.
(L) A statement indicating whether the owner or operator has had past discharges at the facility for which a closure has been granted by the department.(m) A record of investigation results and data interpretation.(n) Contracts for eligible costs incurred because of the discharge and records of the contract negotiations.