Laserfiche WebLink
11/08/95 14:52 UST CLEANUP FUND 912094640138 N0.360 P02 <br /> APPENDIX A <br /> EMERGENCY,ABANDONED,RECALCITRANT(EAR)ACCOUNT <br /> APPROVAL FOR EMERGENCY FUNDING FORM <br /> Upon approval of a verbal request for emergency funding,this form will be completed and signed by the Division <br /> Chief, DCWP(or aGthorized 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 /> Requesting Agency 00flN;y OF .,fA/V ^oA� ii r �NU�QpQIriIgJtRL Ht=�+�rN �jlY <br /> Site Name: <br /> Site Address ✓ S� /�L�J NE +�✓ �u <br /> -- <br /> Amount of Emergency Funds Requested for this Project: OQO. 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 mfigate the emergency <br /> situation and protect public health and safety, A written canfinnatjon of any oral agreements and a copy of all <br /> written contracts must be sent to the Chief DCWP before payments will be made <br /> 1' Signature: <br /> (Person who approved verbal request for emergency funding if other than ChwDCWP) <br /> i <br /> Signature: <br /> ( h f, ) <br /> Within one week of receipt of this farm,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 bunds Approved for this projects:: $—"000 <br /> Invoice Approval Signature. p/1,092 i~dL <br /> (EAR Account Contract <br /> Payment Authorization Signature: <br /> Date of Verbal Approval: /V�y .1c � �g�� CALSTARS CODING: <br /> � p 0550-569.03-3053) <br /> Ear Account Site Number: LF 95~'— REGION: <br /> March 22,1995 <br />