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CALIFORNIA UNDERGROUND STORAGE TANK CLEANUP FUND <br /> COST PRE-APPROVAL REQUEST <br /> (Complete form,enclose required items,sign,date&return) <br /> TO. Linda Sanborn Fax: (916) 341-5806 <br /> I. CLAIM INFORMATION <br /> A. CLAIM NO. B. CLAIMANT Boyett <br /> C. CLAIM STATUS (complete appropriate section) <br /> i) LOC ISSUED FOR $ 0/4/7Z <br /> ii) ON PRIORITY LIST? YES NOS IF YES,PRIORITY CLASS❑A ✓OB❑CE]D <br /> iii)NOT YET APPLIED TO THE FUND,EXPECTED APPLICATION DATE: <br /> D. CONTACT-PERSON: Carl Boyett PHONE: (209) 577-6000 <br /> ADDRESS: PO Box 57627 FAX: (209) 577-6040 j <br /> Modesto, CA 95357 <br /> II. TYPE OF REQUEST(check appropriate boxes) <br /> 0 PRE-APPROVAL$ 30,225 AMOUNT REQUESTED <br /> E]3-BID REVIEW $ PREFERRED BID (if applicable) <br /> THE FOLLOWING DOCUMENTS ARE REQUIRED FOR THE SPECIFIED REQUEST.ALL DOCUMENTS REQUESTED MUST <br /> BE SUBMITTED OR THE REQUEST(S)WILL BE RETURNED UNPROCESSED. <br /> A. REQUEST FOR PRE-APPROVAL OF PROPOSED COSTS-The following items are required before <br /> review and determination will be made by Fund Staff. <br /> 1. ❑A complete signed copy of the proposed Investigation Workplan or Corrective Action Plan <br /> (CAP) (as defined and required by Article 11, Chapter 16, and California Underground Storage <br /> Tank Regulations). Corrective Action Plans must include the required feasibility study and chosen <br /> cost-effective alternative. <br /> 2.E]A signed copy of the oversight agency approval letter for the Workplan/CAP. <br /> 3. n A complete copy of the Request for Bids,including all attachments. A list of all firms <br /> requested to bid must be included. . <br /> 4. ❑Complete copies of all bids and other correspondence submitted in response to the Request for <br /> Bids. <br /> 5. Q✓ A time schedule, if not part of bid documents, anticipated for project initiation and duration. <br /> 6. A detailed project budget, which includes breakdowns of staff/task/hour with associated <br /> estimated totals. <br /> B. THREE-BID REVIEW/EVALUATION/DETERMINATION- Fund staff will assist any claimant <br /> requesting an evaluation of bids upon request. The following information must be submitted- 1,2,3 AND 4 <br /> as described in Item A above. <br /> III. CERTIFICATION <br /> I certify under penalty ofperjury that all information submitted with this request is complete and accurate and in <br /> accordance with all applicable laws and regulations. Must be signed by claimant or person designated on the <br /> Authorized Representative Designation form. <br /> SignatuA8at„� PE Printed Name 1 Date <br /> lPoC.e-[jM <br /> e, <br />