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,L, 530`6E_ N0.026 P.P.3i3 <br /> " MRR'30.20011 12j5EPMFST.WI` RND CORP_ <br /> �ALIFOIWt'UMERGROVND S'tOpAG£TA X CL£A'ti'tJP FUND�( R"COST pRE.Ap.PROVAL REQUEST <br /> (Complete form,enclose require¢hens,Sign,date d•.return) <br /> TO. Linda Sanborn Fa\; (916) 1121«1$36 <br /> I. CLAIM INFOR.4IATION 006055 H. CLAI.V,ANT ''""''''" ��es _ <br /> A. CLAIM N0, <br /> C, CLAN STATUS(Complete approprlatt Serb") <br /> 1) LDC jgSUW FOR S„ 890,020-00 T <br /> ON PAIONTY LIST?C2YE1 ONO C1F YE5.PR'=T)'CLASS ..: A'.-+ B r:.1 C- 'D <br /> Il{) NOT YST APPLIED TO THE FUND,EXPECT'ID APPLICATION DA"M <br /> 1 COIITACTPERSONt John max 1 FA);: <br /> AaDRBSS' cramen o, <br /> 11 ....,rnr TF CT(chcclriinefeerist �o •esf I <br /> ® PltE-APPROVAL S 16,9 0 �.',tOL�T REQl1E5T'ED <br /> LT 3410 REvIE\\' S PR£FERRBD BID (if sltnlitshlo) '- <br /> 77M FOLLO\%1vo DOCVMf8A7S ARS <br /> REgUIREA FOR77IdE SPECIFIED��ATE���� aDECIe S3ED,"is <br /> Mqg -jSTED MUST III 6UMNATTED Q„S1 T1,B RECtt 75 <br /> • s App oV eaennnc bOe7e.7l+e foll0ing items are requiredb:faro mtetk and ' <br /> A, asrltrEeT F00. �•-.��Q i <br /> dela inalton Nit1 be made b)'Fund Staff• <br /> i, A COmplele rfgncd sop)'of tho proposed InvettIVIOn µlorkpian or Corrwive Action Plan(CAA) fss defaad <br /> and required b:•Anieie 11. Chapter 16. Cs!tfornla L•nderilmrtd Imago Tank Rag�lationt), Corrective AC0 i <br /> plans Must include the required faasibilit)•ssud>'and Chesan cult sfieodve alterna)h e, <br /> 2.IA signed copy of the oversisht aliens}' for the WorkplaNCAP, <br /> 9, eontpicts copy of Cha Regvctt for 91ds, incMI-Ai all auachmcr,ts, A list o Ill lhnts requested to bid M. be <br /> cludod. <br /> ., mp1elC aopial of a)I bids and mhor eorresponaan:e submitted in response to the Rcquert for Btdt. <br /> $,Sime ll <br /> sehodulc, if not pntt or bid dOWICnIS, stltiolpnicd for prefect initintion and 'Ilcdfil'Aid <br /> 6.�A dc+olied prajcrt budgCt. which induds brcokde��r,s of atoff task9tour tr(th esso .ited rttin,nted mtall �r <br /> B. <br /> u710*'r4I7EA\1tN '1 N•Fund staff~till xsstst any a!ausaitI re;V6$1inan <br /> c+aluation of bldt upon requoa, The fetlotviny tnforn+.tlon must be submitted• 1.:.' AND.{ as desarlbed In I <br /> lint, A obovd. <br /> 1U, i8IIF1CATIQuI Fi. eNeu rr-b IdnrA rith Side rrgvxr a mnlpK ro 1ud oeet,ron utA Ix aerrr/e1+er rddt <br /> 1 Geit(6?I(ndlYfroplg Q(pe�un ' or eR �" <br /> all 4mjivable low e11d rquivio n, t <br /> 1 NI V <br /> S <br /> Dote <br /> In tuft <br /> Printed N:nte <br /> athoriiatfon for the fwd to glee out )our name and phone numbwo other clain•:ms In your nylon as a' <br /> rerercn:a for cons4itants and tentfnetora. O 1'ES ❑ NO <br /> Slgnnrore Date <br />