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CALIFORNIek UNDERGROLIND STORAGE TANK CLEANUP FUND } <br /> COST PRE-APPROVAL REQUEST <br /> ` (Ccmp(ec_ focn, enc(ese required items, sign, date 8t.recurn) <br /> TO: `zi La Fax: (416) 227-45330 <br /> LIST Clea up Fund, 201- T St-eetf Sacramento, C4 95814 <br /> I. CLAIM INFORMATION <br /> J . <br /> A. CLAIM NO. y 7 B. CLAIMANT fY^r r ei?f?/1/t <br /> C. CLAIM'ST.=.T i IS (corn:1___ appropriate sec*.icn) <br /> { LOC ISSUED FOR 5 <br /> ON PRIORITY LIST —ZYi:S NO IF YES, PRIORITY CLASS II A B C!C L D <br /> NOT YET FILED, EXPECTEDFILE DATE: <br /> CONTACT PERSON: Gcyr;�.lA PHONE: Zo z <br /> AD D RES-S: 31-7 Tom-' FAX: <br /> If I(. TYPE OF RF EST (check appropra:= boxes) <br /> PR:-.-PPROV�.L 3-BID REVIEW <br /> T':-'"= FOLLOWING DOCUMENTS AIZE REQUIRED FOR THE SPECIFIED REQUEST. -ALL DOCUMENTS <br /> ' REQUESTED MUST 8E SUBMI �t 1 ED IN T:IEIR ENTIRE i f OR THE REQUEST(S) WILL Sr- REi UmED 1 <br /> UNPROCESSED: <br /> A. PE-QUEST FOR PR' ;;PPROVAL OF PROPOSED COSTS The fo(Iowin; ftenu are re-aired b_ bre <br /> i a-d dererminstien will be by Fund s'�Fn. <br /> 1. �A CCr7pfec_ si�etc� CO y Ce Ci= prOpased lav=_sti;stior, Workplan (IP) or Ccrr.cciv=_ r C:iOn :Lan <br /> 1 <br /> (CAP) (as de::ned and reri ;red by r.rdcfe 1 1, Chancer 16, C=linornia Llnder;rcund Storave Tank <br /> R;;sladons). Ccrreccive r".Cdcn Flans rnust inciud? the required fe?si rilfty study and chosen - <br /> C4S's•_FfecCl�'�,aIC2i ii3tiVz. <br /> ?. .�A sivned Copy of&.e oveMi ;st ZM'cy approval letter for the IP/CAF. <br /> 3. _n Complete copy of d�e Re quest For Bids, includfn,all attachments. A list of aII Is.-r.3s r2quste to <br /> bid must be included. <br /> 4 _,Cor, piece copies of a[1 bids and ether corrzspondence submitted in response to rile Request For bids. <br /> I <br /> S. _A. time schedule, if net part of bid documents, anticipated for project initiation and duration. <br /> S <br /> 6. 4A der.:iled project bud;5t, xnich incfudes breakdowns of s=Mr1cask/hour with associated esd,-nate'd <br /> to eels. <br /> B. <br /> TPR:-:,-3rD ArVIEW/EVA' UATION/Dr i� I_RMINATION - Fund staf;will =ist any clairkm t r?suemn;an <br /> evaluadon of bids upon request- The fo(lowin;infari<adon must be submict=_d - 1, 2, 3 AND 4 as desetbed <br /> in Item ab;c=Je. - <br /> I1L CER T(FICATION <br /> I c'r"dFy under penalty OFpedur/ Gc3t 311 ln,'Orniltion subrnit:ed with this request is complete and accurate and in <br /> accordance with all applicable livvs . d re— <br /> Sign <br /> ed�l=tit)ns. <br /> Signed <br /> Dared 7�9196 urcf aza.cs� alrvsN«r <br /> I <br />