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CALIFORNIA UNDERGROUND STORAGE TANK CLEANUP FUND <br /> COST PRE-APPROVAL REQUEST <br /> (Complete form, enclose required items, sim date & return) <br /> TO : Linda Sandborn Fax: (916) 341 -5806 <br /> L CLAIM INFORMATION <br /> A. CLAIM NO. 008449 B CLAIMANT Canapas Car Wash <br /> C. CLAIM STATUS (complete appropriate section) <br /> i) LOC ISSUED FOR $ 350,000 <br /> ii) ON PRIORITY LIST? YES✓ NOE] IF YES, PRIORITY CLASS E]A ✓1B ❑CD]D <br /> NOT YET APPLIED TO THE FUND, EXPECTED APPLICATION DATE: <br /> D. CONTACT PERSON: Remo Canapa PHONE: (209) 478-5515 <br /> ADDRESS : 1536 Hunter Street FAX: (209) 478-6342 <br /> Stockton, CA 95207 <br /> II. TYPE OF REQUEST (check appropriate boxes) <br /> 0 PRE-APPROVAL $ 269868o85 AMOUNT REQUESTED <br /> 3-13ID REVIEW $ PREFERRED BID (if applicable) <br /> THE FOLLOWING DOCUMENTS ARE REQUIRED FOR THE SPECIFIED REQUEST. ALL DOCUMENTS REQUESTED MAST <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 . F✓ 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. ✓v A signed copy of the oversight agency approval letter for the Workplan/CAP. <br /> 3 . 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. R✓ 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. u 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 /> M. 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 orperson designated on the <br /> Autho ized Representative Designation form. <br /> Signature YJ Printed Name Date <br />