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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />REQUEST FOR PAYMENT — PART 11 <br />REIMBURSEMENT DETAIL <br />Grantee Name: <br />Payment Request No.: <br />DEP Agreement No.: <br />Vendor Name <br />Local Share or Other <br />Invoice Invoice Date Invoice Amount Funding or Amount <br />Number (1) Not Requested (2) <br />rable <br />Requested Amount (3) Check Number Task/, ber (44)) <br />Number <br />S <br />$ <br />S <br />$ <br />S <br />$ <br />S <br />$ <br />S <br />$ <br />S <br />$ <br />S <br />$ <br />$ <br />$ <br />Totals: <br />$ - <br />$ <br />Attachment B-1, DEP Agreement No. S0839, Page 5 of 6 <br />