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10/16"95 15:41 UST CLEANUP FUND 912094640138 N0. 112 912 <br /> APPENDIX A <br /> EMERGENCY, ABANDONED, RECALCI`1'RA%' (EAR) ACCOUNT <br /> ` APPROVAL FOR moRmwcy FIItDINCa FORM <br /> Upon approval of a verbal request for emergency funding, this form will <br /> be completed and signed by the Division Chief, DCWP (or authorised <br /> representative) and forwarded to the Regional Water Board Executive <br /> officer or the Local Implementing Agency's Director and to the State <br /> Water Board's Accounting office for encumbrance. The Accounting Office <br /> requires three copies with original signatures. <br /> Requesting Agency: <br /> Site Name: <br /> Site Address : <br /> Amount of Emergency Funds Requested for this Project: $ <br /> The requesting agency is hereby authorized to enter into oral or written <br /> contracts with qualified contractors to take the required emergency <br /> corrective action or they may initiate direct site cleanup necessary to <br /> mitigate the emergency situation and protect public health and safety. <br /> A written confirmation of any oral agreements end a cant' of all wr iten <br /> contracts must be sent to the Chief QCWP before nawrnents will be mads. <br /> Signature: _ Date: <br /> (Person who approved verbal request for emergency funding if other <br /> than Chief, DCWP) <br /> Signature: Date : <br /> (Chief, nCWP) <br /> Within one week of receipt of this form, the requesting agency must <br /> provide a written summary description of the Project, including all <br /> site-specific information specified in the Funding Criteria Section of <br /> this AFM. <br /> Amount of Emergency Funds Approved for tris Project : $ <br /> Invoice Approval Signature: <br /> (EAR Account Contract Manager <br /> Payment Authorization Signature: <br /> Date of Verbal Approval: <br /> EAR Account Site Number: T_. <br /> CALSTARS CODING:: <br /> 0550-706-0531 <br /> REGION: <br />