Laserfiche WebLink
RUSS CHAPIN 209-464-6947 10-27-95 09:47 P.03 <br /> CALIFORNIA UNDERGROUND STORAGE TANK CLEANUP FUND <br /> COST PRE-APPROVAL REQUEST <br /> (Complete form,enclose tegtrired Items,sign,date tat return) <br /> TO: Fax_ (916) 227-4530 <br /> UST Cleanup Fund,2014 T Street,Sacramento, CA 95814 <br /> I. CLAIM INFORMATION <br /> . i <br /> A. CLAIM NO. T B. CLAIMANT- <br /> C. CLAIM STATUS (complete appropriate section) <br /> LOC ISSUED FOR$ <br /> ON PRIORITY LIST YES NO IF YES, PltORITY CLASS ©A CJ g ❑C D D <br /> - r <br /> NOT YET FILED, EXPECTED FILE DATE: <br /> CONTACT PERSON; PHONF: <br /> ADDRESS: ---- FAX: <br /> IL TYPE OF REQUEST (check appropfiate boxes) <br /> PRE-APPROVAL !� 3-0I1) REVIEW <br /> THE FOLLOWING DOCUMENTS ARE REQUIRED FOR THE SPECIFIED REQUEST, ALL DOCUMENTS <br /> Rf_QUESTLD MUST BE SUBMITTED IN THEIR ENTIRETY OR THE REQUESTS) WILL$E RETURNED <br /> UNPROC>SSED. <br /> A. RMUFS] FORTR.F-APPROVAL OF PROPQR> 7 - The following iters are required before review <br /> and determination will he made by Fund staff. <br /> 1. ___A complete signed copy of the proposed investigation Workplan (iP) or Corrective Action-Plan <br /> (CAP) (as defined and required by Article 11, Chapter 16, California Underground Storage Tank <br /> Rerulatlons). Corrective Acton Plans must include the required feasibility stuffy and Chosen <br /> cost-effective alternative. <br /> 2. .. A slEated copy of the oversight agency aptstoval letter for the IP/CAP. <br /> 3. A complete copy of the Request For Rlds, Including all attachments.-A list of all firms requested to <br /> bid must be Included. <br /> 4. _ ._Conipiete copies of all bids and other correspondence submitted In response to the'Request for bids. <br /> S. _...A time schedule, if not part of bid documenLt, anticipated for project Initiatlon and duration. <br /> 6... -A detailed project budget,which includes breakdowns of staff/task/hour with associated estimated <br /> totals. <br /> B, ]kiR>tiE-BI_[) REVIEW/EVALLIATION/DETERMINATIQ�J,- fund staff will assist any claimant requesting an <br /> evaluaslon of itids upon request. The following information must be submitted - 1, 2, 3 AND 4 as described <br /> In Item A above. <br /> Ili. CJF1CA)1Qhj <br /> 1 certify under-penalty of perjury that all Information submitted with this request is complete and accurate and In <br /> accordance wirh ail applicable laws and regulations. <br /> Signed <br /> Dated -- _ _ uslcFore.csl otMMW <br /> r , <br /> r <br />