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California Department of Corrections and Rehabilitation <br /> TASK ORDER <br /> Instructions: This task order is used to request repair services under Agreement #C5609245 <br /> Aboveground and Underground Storage Tank Systems Inspection, Testing, Maintenance, Repair and <br /> Certification Services. The Institution Contract Liaison will complete Section A, save as a pdf file and <br /> email to: CDCR(@USTSERVICES.com with copy to: EnvironmentalComplianceProgram(a)_cdcr.ca.gov. <br /> The contractor will complete Section B and return to the Institution Contract Liaison for approval. The <br /> Institution Contract Liaison will indicate approval to proceed with the repair work by signing electronically <br /> and submitting back to the Contractor. Once the repairs have been completed, the Contractor will submit <br /> the completed task order with the invoice for payment. <br /> SECTION A (TO BE COMPLETED BY INSTITUTION CONTRACT LIAISON) <br /> Institution: NCYCC Date of Request: 9/13/21 <br /> Institution Contact Name: Susie Ayers Phone #: 209-944-6526 <br /> Aboveground Storage Tank Underground Storage Tank <br /> Tank ID: Gasoline Tank <br /> ISSUE: <br /> RETURN TO ADDRESS PREVIOUS ISSUE#3 <br /> Reconfigure piping to access overfill valve, check overfill valve is set to correct level. <br /> 3)The overfill prevention valve was not accessible during the inspection today. According to the fill pipe tag the tank <br /> is equipped with a 9095 series valve (see attached info sheet). Condor recommends consulting a tank contractor or <br /> using staff maintenance to further inspect the overfill prevention device and check the calibration of the shutoff level. <br /> SECTION B (TO BE COMPLETED BY CONTRACTOR) <br /> Description of work to be performed (identify the problem, list the repairs and/or <br /> equipment or parts that may be used to complete the task order): <br /> SEE ATTACHED ESTIMATE 20180645R2 <br /> Cost Estimate (attach if necessary): $5,039.55 <br /> The State assumes no responsibility for any work commenced by the Contractor and will not reimburse <br /> the contractor for any work performed prior to approval and scheduling by the Institution Contract Liaison <br /> or designee. Payment will only be made on invoices accompanied by a Task Order signed by the <br /> Institution Contract Liaison or designee. <br /> Institution Contract Liaison: Digitally signed by Susie <br /> Susie Ayers <br /> Susie Ayers Dates 2021.09.2909:39:01 9/29/21 <br /> Print Name Here Signature Date <br /> Page 1 <br />