ATCP 35.06(1)(c) (c) A “total reimbursement costs form” containing all of the following:

ATCP 35.06(1)(c)1. 1. The total eligible corrective action costs for which the responsible person seeks reimbursement from the department.

ATCP 35.06(1)(c)2. 2. Other relevant information requested by the department.

ATCP 35.06(1)(d) (d) An “insurance information form” containing all of the following:

ATCP 35.06(1)(d)1. 1. A statement indicating whether any portion of the corrective action costs for which the responsible person seeks reimbursement may be covered by insurance, or a statement from the responsible person’s insurance company stating that the insurance company has denied the responsible person’s claim for reimbursement of the corrective action costs.

ATCP 35.06(1)(d)2. 2. Other relevant information requested by the department.

ATCP 35.06(1)(e) (e) A map showing the township, range, section and quarter-quarter section location of the discharge site. If the agricultural chemical was discharged while being transported from a site owned or controlled by a person who owned or controlled the agricultural chemical at the time of the discharge, the application shall include a second map showing the township, range, section and quarter-quarter section location of the site from which the agricultural chemical was being transported.

ATCP 35.06(1)(f) (f) An accurate legal description of the land parcel on which the discharge site is located. If the agricultural chemical was discharged while being transported from a site owned or controlled by a person who owned or controlled the agricultural chemical at the time of the discharge, the application shall also include an accurate legal description of the land parcel on which that site is located. A parcel description under this paragraph shall correspond to the parcel description that was on record, at the time the discharge occurred or was discovered, with the register of deeds in the county where the land parcel is located.

ATCP 35.06(1)(g) (g) A summary statement identifying each eligible corrective action cost for which the applicant seeks reimbursement from the department. The statement shall include each eligible corrective action cost, paid by the applicant prior to the date of the reimbursement application, for which the applicant seeks reimbursement. The summary statement shall allocate each cost to one of the following categories:

ATCP 35.06(1)(g)1. 1. Soil investigation.

ATCP 35.06(1)(g)2. 2. Soil remediation.

ATCP 35.06(1)(g)3. 3. Laboratory and other analysis.

ATCP 35.06(1)(g)4. 4. Groundwater investigation.

ATCP 35.06(1)(g)5. 5. Groundwater remediation.

ATCP 35.06(1)(g)6. 6. Miscellaneous.

ATCP 35.06 Note Note: Under s. ATCP 35.08 (5) (b), if any person applies for reimbursement of an ineligible cost, the department may deduct twice the amount of that cost from that person’s reimbursement application if the responsible person knew or should have known that the cost was not eligible. If a responsible person is not certain whether a corrective action cost is eligible for reimbursement under this chapter, the responsible person may contact the department for a preliminary opinion under s. ATCP 35.08 (1).

ATCP 35.06(1)(h) (h) Invoices or other information documenting each of the costs under par. (g). Documentation shall identify 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.

ATCP 35.06(1)(i) (i) Canceled checks or other information documenting that the applicant has paid all of the costs under par. (g).

ATCP 35.06(1)(j) (j) All of the following, for each cost item under par. (g):

ATCP 35.06(1)(j)1. 1. Every bid required under s. ATCP 35.16 (2) (a), including every accepted and rejected bid. Each bid shall indicate the name of the contractor and the amount of the bid.

ATCP 35.06(1)(j)2. 2. Every cost estimate required under s. ATCP 35.16 (2) (c) 3., including the name of the contractor and the amount of the cost estimate.

ATCP 35.06(1)(j)3. 3. Every authorization required under s. ATCP 35.16 (2) (c) 5., including the name of the contractor and the amount of the authorization.

ATCP 35.06(1)(k) (k) A spreadsheet that identifies and matches each invoiced cost in par. (h) with the documentation under pars. (i) and (j) supporting that invoiced cost.

ATCP 35.06(1)(L) (L) A substitute W-9 tax form.

ATCP 35.06(1)(m) (m) Other relevant information required by the department.

ATCP 35.06 Note Note: To obtain application materials, contact the Department of Agriculture, Trade and Consumer Protection, Agricultural Resource Management Division, P.O. Box 8911, Madison, WI 53708. The department will provide application materials, including illustrative examples and all of the forms required under pars. (a) to (d) and (L). Reimbursement paid to a responsible person under this chapter may be reportable, for tax purposes, as income received by that person.

ATCP 35.06(2) (2) Application frequency. A responsible person may not submit more than one application under sub. (1) within any 12- month period for the same discharge site.

ATCP 35.06(3) (3) False, deceptive or misleading representations.

ATCP 35.06(3)(a) (a) No person may make, or conspire with another person to make, any false, deceptive or misleading representation in connection with any reimbursement application under this section.