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Mar-20-97 09:27A Feb- P.07 <br /> 16 <br /> CALIFORNIA UNDERGROUND STORAGE TANK CLEANUP FUND <br /> COST PRL.-APPROVAL REQUEST <br /> (Complete form,enclose required items,sign, dace &return) <br /> TO: Fax. (916) 227-4530 <br /> LIST Cleanup Fund, 2014 T Street,Sacramento, CA 95814 <br /> I. CLAIM]INFORMATION <br /> A. CLAIM NO. B. CLAIMANT <br /> C. CLAIM STATUS (complete approprlate'section) <br /> LOC ISSUED FOR S <br /> ON PRIORITY LIST YES NO IF YES, PRIORITY CLASS A Q B Q C ©D <br /> NOT YET FILED, EXPECTED FILE DATE: <br /> CONTACT PERSON: PHONE; <br /> ADDRESS: FAX: <br /> IL TYPE OF REQUEST(check appropriate boxes) "� <br /> ❑ PRE-APPROVAL lJ 3-BID REVIEW <br /> THE FOLLOWING DOCUMENTS ARE REQUIRED FOR THE SPECIFIED REQUEST_ ALL DOCUMENTS <br /> AEOLIESTED MUST BE SUBMITTED IN THEIR ENTIRETY OR THE REQUEST(S) WILL BE ILETURNED <br /> UNPROCESSED, <br /> A. REQUEST FOR P E-APPROVAL P - The following items are required before review <br /> and detenriination will be made by Fund surf. <br /> 1•�A canplete signed copy of the proposed invt0gation Workplatf (IP) or Corrective Action Plan <br /> (CAP) (as defined and required by Article 1 1CaliforniaUnderground Storage Tank <br /> , Chapter 16, Cali <br /> Regulations). Corrective Action Ptans must include the required feasibility study and chosen <br /> cosi-effective alternative. <br /> 2._A signed copy of the oversight agency approval letter for the IP/CAP. <br /> 3._A complete copy of the Request For Bids, including all MIChments. A list of all firms requested to <br /> bid must be included_ <br /> 4._Complete Copies of all bids and other correspondence submitted In response to the Request For bids. <br /> S. ,,,_A tune 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 estimated <br /> touts. <br /> B. - 1 W V 1 -f - Fund tuff will assist any claimant requesting an <br /> evaluation of bids upon request. The following information must be submitted- I, 2, 3 AND 4 as described <br /> in Item A above. <br /> Ill. QRTIFICATION <br /> certify under penarty of perjury that aff information submitted with this request is complete and accurate and in <br /> accordance with all applicable laws and regulations. <br /> Signed <br /> Dated ustcr o:•.csT osnsMw <br /> t 'd 00LO 9S6 6W DN 30V k0b_A Vl`d£S=S L6Bl—tri—ir <br />