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California Department of Corrections and Rehabilitation TASK ORDER Instructions: This task order is used to request repair services under Agreement #C5609245 Aboveground and Underground Storage Tank Systems Inspection, Testing, Maintenance, Repair and Certification Services. The Institution Contract Liaison will complete Section A, save as a pdf file and email to: CDCR(aD_USTSERVICES.com with copy to: EnvironmentalComplianceProgram(d-)cdcr.ca.gov. The contractor will complete Section B and return to the Institution Contract Liaison for approval. The Institution Contract Liaison will indicate approval to proceed with the repair work by signing electronically and submitting back to the Contractor. Once the repairs have been completed, the Contractor will submit the completed task order with the invoice for payment. SECTION A (TO BE COMPLETED BY INSTITUTION CONTRACT LIAISON) Institution: NCYCC Date of Request: 9/13/21 Institution Contact Name: Susie Ayers Phone #: 209-944-6526 Aboveground Storage Tank ❑✓ Underground Storage Tank Tank ID: Gasoline Tank ISSUE: 1)The operational vent equipment tag (EVR)indicated it was past due for removal (see attached picture) 2)The liquid level gauge level (1ft, 9.5in)appeared to be within 1.5 to 2 inches of the manual measurements(1ft, 7.5in) collected today .The liquid level gauge should be calibrated using the manufacturer's instructions(see attached). 3)The overfill prevention valve was not accessible during the inspection today.According to the fill pipe tag the tank is equipped with a 9095 series valve (see attached info sheet). Condor recommends consulting a tank contractor or using staff maintenance to further inspect the overfill prevention device and check the calibration of the shutoff level. 4) Fuel is dispensing gas slowly. SECTION B (TO BE COMPLETED BY CONTRACTOR) Description of work to be performed (identify the problem, list the repairs and/or equipment or parts that may be used to complete the task order): See attached estimate 20180645 Cost Estimate (attach if necessary): $2,735.19 The State assumes no responsibility for any work commenced by the Contractor and will not reimburse the contractor for any work performed prior to approval and scheduling by the Institution Contract Liaison or designee. Payment will only be made on invoices accompanied by a Task Order signed by the Institution Contract Liaison or designee. Institution Contract Liaison: Digitally signed by Susie Susie Ayers Susie AyerAyers Dates 2021.09.1412:36:14 07'00' Print Name Here Signature Date Page 1