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�y APPENDIX A <br /> EMERGENCY,ABANDONED, RECALCITRANT(EAR);ACCOUNT <br /> APPROVAL FOR EMERGENCY FUNDING FORM <br /> D , <br /> Upon approval of a verbal request for emergency funding,this form will be completed and signed by the Division <br /> Chief, DCWP (or authorized representative) and forwarded to the Regional Water Board Executive Officer or the <br /> Local Implementing Agency's Director and to the State Water Board's Accounting Office for encumbrance. The <br /> Accounting Office requires three copies with original signatures. <br /> RequestingAge_y- Oouty�✓ OF SIN Egkr/4 <br /> Site Name: Z- FI. Gi FF//V <br /> Site Address, '75 60Sr /9—Le/NE 4 V6N U-E , <br /> �fi 7aN CP <br /> Amount of Emergency Funds Requested for this Project: $ 0� 00�. 00 <br /> The requesting agency is hereby authorized to enter into oral or written contracts with qualified contractors to take the <br /> required emergency corrective action or they may initiate direct site cleanup necessary to mitigate the emergency <br /> situation and protect public health and safety. A written confirmation of any oral agreements and a copy of all <br /> written contracts must be sent to the Chief, DCWPbeforepayments will be made. <br /> ��` � <br /> X Signature: el 71— nota. <br /> (Person who approved verbal request for emergency funding if other than Chief, DCWP) <br /> Signature: <br /> ( hief, ) <br /> Within one week of receipt of this form,the requesting agency must provide a written summary description <br /> of the project, including all site-specific information specified in the Funding Criteria Section of this APM. <br /> Amount of Emergency Funds Approved for this project:/$ 000 <br /> Invoice Approval Signature: Ic/2�c" Qa G /� <br /> (EAR Account Contract <br /> Payment Authorization Signature:/� <br /> Date of Verbal Approval: UtM6E"l 3. /19s CALSTARS CODING: <br /> Q�Or Z O 0550-569.03-30531 <br /> Ear Account Site Number: 'OF <br /> CJs— CSI REGION: 0,5 - <br /> March 22, 1995 <br />