Laserfiche WebLink
BAGt_IETTO SEEDS Fax:209-466-6377 Sep 22 '97 9:59 P.05i06 <br /> nau>u►.maiuil,ia unjuergrvauu aturtage i*man% lInnvp FUno - State water Resources Control Bond <br /> mtnjal <br /> FirvironProtection AgcrncY 'T i ER OF COMMITMENT � (Rsvlsrd 4197) <br /> DATASHEET <br /> Claimant: Claim No.. <br /> TULEBURG WAREHOUSE 12586 <br /> Claim Contact: Telephone No-: <br /> F. RAUZI <br /> The information requested on this form must be completed within tett(10)working days of receipt of this form or the <br /> issuance of your Letter of Commitment may be delayed. It is important that the information provided be as aecuraye rind <br /> co> &as possible. Once a Letter of Commitment is issued and funding is committed to reimburse you for your <br /> eligible costs,you will be required to submit your first reimbursement request within 90 calendar days from the date of <br /> the tetter transmitting the Letter of Commitment. Failure to submit your reimbursement request within 90 days will <br /> result in steps taken to withdraw your better of Commitment. <br /> I. SITE STATUS/COSTS <br /> 1. INCURRED(PAST)COSTS: $ <br /> T� a t p Et t 1t� L t< � U� 5ca i c_ Sifm pt- <br /> DESCx[aE ACT[v[T[i;5(WORK CONAUCTED): <br /> 2. PROPOSED(FUTURE)COSTS: $ 'V yvl S t5 fl (WITHIN THE NEXT 6 MONTHS) �] <br /> DESCRIBEAGTIvITms(PROPOSED WORK): ttil(S2ILV0V1-1 - W_ <br /> C.�012-IL. 'fa 007—iyvye <br /> n►- ` �`�QOt�EU►v� [�V a,e�cp�g d nIS - r�vr, � Q 02,vn t-C F TZ- l a g4 6re}5_ <br /> NOTE: The initial amount of your Letter of Commitment will be based substantially upon the information you supply <br /> above. You may provide additional information regarding the corrective action activities on the back of this form. <br /> Failure to complete this information will delay the award of your Letter of Commitment. <br /> II. INCURRED COST SUMMARY <br /> List a completc summary of eligible corrective action costs incurred to date. Do not include tank removal costs,attorney <br /> fees. At this time,you are not required to submit the actual invoices or list individual invoices. List the firms and the <br /> total costs for each firm. An example summary is provided below: <br /> 1IHM u� , i"� UU LAM <br /> IIAA� $34,575-Off-- <br /> Z_ f(J( <br /> 34.575-O GflJ( + <br /> &W 1� l <br /> NOTE: Only list those firms which have actually invoiced you. Do not li"roposals. Do not list subcontractors whose <br /> bills are already included in the prime consultant/contractor invoice. <br /> COMPLETED BY: / DATE: <br /> CLAIMANT SIGN <br /> DATE: <br /> RETURN COMAT ,D RM TO: Annabel Mackey,Claim Review Unit <br /> State Ater Resources Control Board,P.O.Box 944212,Sacramento,CA 94244-2120 <br />