93-59 Island Environmental Services - Underground Storage Tank RemovalOWNER - GENERAL CONTRACTOR
AGREEMENT
THIS AGREEMENT, made this 8th day of November, A.D., 1993, between the Kodiak Island Borough,
acting by and through its Borough Mayor, party of the first part, and Island Environmental Services of
Kodiak, Alaska.
A CORPORATION, incorporated under the laws of the State of Alaska its successors and assigns, party
of the second part, hereinafter called the Contractor.
WITNESSETH: That the Contractor, for and in consideration of the payment or payments herein
specified and agreed to by the party of the first part, hereby covenants and agrees to furnish and install
the materials and to do and perform all the work and labor required in the construction of Underground
Storage Tank Removal in the Kodiak Island Borough, Kodiak, Alaska, for the sum of twelve thousand
nine hundred and six dollars ($12,906).
The Contractor further covenants and agrees that the entire construction shall be done under the
administration and to the complete satisfaction of the Kodiak Island Borough subject to inspection at
all time and approval by any participating agency of the Government of the United States of America,
and in accordance with the laws of the State of Alaska and rules and regulation of said Federal
Agency.
The Contractor further covenants and agrees that all of said work and labor shall be done and
performed in the best and most workmanlike manner and that all and every of said materials and labor
shall be in strict and entire conformity in every respect with the Contract documents: that he will
abide by and perform all stipulations, covenants, and agreements specified in said Contract documents,
all of which are by reference hereby made a part of this Contract, as to all premises therein: and in
case any of said materials or labor shall be rejected by the Borough Mayor or his assistant or authorized
representative, as defective or unsuitable, then the said materials shall be removed or replaced with
other approved materials and the said labor shall be done anew, to the satisfaction and the approval
of the Borough Mayor or his representatives, at the cost and expense of the Contractor.
The Contractor further covenants and agrees that all of said materials shall be furnished and delivered
and all labor shall be done and performed, in every respect, to the satisfaction of the herein
aforementioned Borough Mayor, on or before 5 days from Notice to Proceed. Itis expressly understood
and agreed that in case of the failure on the part the Contractor for any reason, except with the written
consent of the Borough Mayor, to complete the furnishing and delivery of said materials and the doing
and performance of the said work before the aforesaid date, the party of the first part shall have the
right to deduct from any monies due or which may become due the Contractor , or if no monies shall
be due, the party of the first part shall have the right to recover Two Hundred Dollars ($200) per day
for each and every calendar day elapsing between the time stipulated, and the actual date of completion
in accordance with the terms thereof: said deduction to be made, or said sum to be recovered not as
penalty, but as liquidated damages. Provided, however, that upon receipt of written notice from the
Contractor of the existing causes over which said Contractor has no control and which must delay the
completion of said work, the Borough Mayor may at his discretion, extend the period hereinbefore
specified for the completion of the said work, and in such case the Contractor shall become liable for
said liquidated damages for delays commencing from the date on which said extended period shall
expire.
532-13 - Agreement
Page 1 of 3
It is distinctly understood and agreed that no claim for additional work or materials, not specifically
herein provided, or furnished by the Contractor, will be allowed by the Borough Mayor, nor shall the
Contractor do any work or furnish any material not covered by this contract, unless such work is
ordered in writing by the Borough Mayor. In no event she" the ContlaCtue *11CUI any liability by reason
of any verbal directions or instructions that he may be given by the Borough Mayor, or his
representatives, nor will the said party of the first part be liable for any materials furnished or used, or
for any work or labor done, unless said materials, work or labor are required by said Contractor on
written order furnished by the Borough Mayor. Any such work or materials which may be done or
furnished by the Contractor without written order first being given shall be at the said Contractor's own
risk, cost and expense and he hereby covenants and agrees that without such written order he shall
make no claim for compensation for work or materials so done or furnished.
Any dispute arising under this contract which is not disposed of by agreement between the Contractor
and the Project Manager shall, at the request of the Contractor, be decided by the Contracting Officer
who shall reduce his decision in writing and mail or otherwise furnish a copy thereof, to the Contractor.
The Contracting Officer reserves the right to make written request to the Contractor at any time for any
additional information needed to make his decision. The decision of the Contracting Officer shall be
final and conclusive unless, within 30 days from the date of receipt of such copy, the Contractor mails
or otherwise furnishes to the Kodiak Island Borough Assembly, a written appeal. The Notice of Appeal
shall include specific exceptions to the Contracting Officer's Decision, including specific provisions of
the contract relied upon. General Assertions that the Contracting Officer's Decision is contrary to law
or, to fact, are not sufficient.
The decision of the Kodiak Island Borough Assembly shall be rendered within 120 days of the Notice
of Appeal. The decision shall be final and conclusive unless determined by a court of competent
jurisdiction to have been fraudulent, or capricious, or arbitrary , or so grossly erroneous as necessarily
to imply bad faith.
The Disputes article does not preclude consideration of questions of law in connection with decisions
provided for above. Nothing in this contract, however, shall be construed as making final the decisions
of the Kodiak Island Borough Assembly or its representative on a question of law.
At all times during the time that a dispute is pending and in the process of being resolved or decided,
the Contractor shall proceed diligently with the work so as to achieve, if at all possible , performance
of the work within the contract allotted time.
The Contractor hereby agrees to receive the prices set forth in the proposal as full compensation for
furnishing all the materials and labor which may be required in the prosecution and completion of the
whole work to be done under this contract, and in all respects to complete said contract to the
satisfaction of the Borough Mayor.
It is further distinctly agreed that the said Contractor shall not assign this contract, nor any part thereof,
nor any right to any of the monies to be paid him hereunder, nor shall any part of the work be done or
materials furnished under this contract.
532-13 - Agreement
Page 2 of 3
IN WITNESS WHEREOF, The Kodiak Island Borough Mayor, by authority in him vested, has executed
this contract on behalf of the Kodiak Island Borough, and the said
have hereunto set their hands and seals, the day and year first above written.
KODIAK ISLAND BOROUGH CONTRACTOR //�J'!f�`/////t
-2S!�"-j ZZ4zZ, X
Borougb Mayr Ti le: President
By �iVP_ jY e it -8-93
/EngineerincjVFdcilitW Director
Attest:
By 1144
Borough C e k
532-13 - Agreement
Page 3 of 3
Kodiak Island_ Borough
AGENDA STATEMENT
Meeting of: November 4, 1993
ITEM NO. 12.E -6 -
Contract No. 93-59
ITEM TITLE: Borough Building UST Removal and Inspection
SUMMARY STATEMENT:
An oil release has been identified from the 5,000 gallon U.S.T. behind the Data
Processing Dept. at the Borough Building. Immediate response and action is
required from the ADEC. Quotes were requested from AK Construction & Island
Environmental Services which has the certification needed. Recommend award to
Island Environmental Services, low bidder.
FISCAL NOTES ACCOUNT NO. 220-232-450-430
N/A Expenditure Amount
Required $12,906 Budgeted $ 20,000
APPROVAL FOR AGENDA:
WALTER J. HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
SOUTHCENTRAL REGIONAL OFFICE Telephone: (907) 563-6529
Contaminated Site Programs Fax: (907) 273-4331
3601 C Street, Suite 1334
Anchorage, AK 99503
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
NO. P 521 088 693
October 25, 1993
Jerome Selby
Kodiak Island Borough
710 Mill Bay Road
Kodiak, AK 99615
Re: Notice of Release, Kodiak Island
UST Facility ID#: UST Registration -Facility ID 2936
Lat: Long:
Legal Description:
SPILL #: 93-2-5-00-284-1
Dear Mr. Selby:
07 2 I 03
Our office has received a report stating a petroleum release occurred from an underground storage
tank system (UST) at the Kodiak Island Borough building, 710 Mill Bay Road, Kodiak. AK 99615.
This release occurred from tank ID 1, an UST partly used as an emergency generator. This letter
confirms that the release was reported to Bill Reith of the department's Kodiak Field office on
October 11, 1993. Notification of this release has not been given to other agencies.
Information provided on release
The release was reported by Robert Trousil, Environmental Engineer, on behalf of your facility.
According to Mr. Trousil your agency apparently first had knowledge that a release had occurred on
the morning of October 11, 1993, the date the release was reported. The responsible party for the
facility appear to be Kodiak Island Borough, 710 Mill Bay Road, Kodiak, AK 99615 (Ph: 486-9343).
According to Mr: Trousil:
the type of product released is diesel number 2;
the cause of the release is not confirmed but was believed to a return line leak:
the tank was tested tight last year;
oil was observed weeping between cement gutter and asphalt of a parking lot; the surface area
contaminated is approximately 100-150 square feet;
the volume of contaminated soil is unknown;
no soil has been excavated or stockpiled;
contamination of principal water supplies is not known to have occurred.
Mr. Jerome Selby -2- October 25, 1993
- within I mile of the site, there are ground water is not believed to be used. Access to the site
is uncontrolled;
- the site is in a suburban area;
- there are occupied buildings within 500 feet of the site; these occupied buildings include a
high school approximately 500-1,000 feet away
- no personal injuries were reported from the release;
actions have been taken to contain or cleanup the release; these actions include removal of
fuel from the tank and use of absorbent pads to contain the spread of fuel on the parking lot;
- no additional fuel is seeping; within the next two weeks the borough intends to dig a trench to
contain the release.
Requirements
Alaska's Underground Storage Tank (UST) Regulations (18 AAC 78) contain specific requirements
for responding to releases from regulated USTs. The following information is provided as a
summary of current laws, regulations and guidelines to further assist you in responding to the release.
In accordance with 18 AAC 78.220, within 24 hours of discovering a release the owner or operator
must report the release to the department, take immediate action to prevent further release and
identify and reduce fire and safety hazards. In addition to reporting the release, the owner or
operator of the UST must perform Initial Abatement and a Site Assessment/Release Investigation,
in accordance with 18 AAC 78.230, including the following:
continuing to monitor and reduce fire and safety hazards;
reviewing inventory control records and repair records;
—� determining the type of backfill used around the UST;
estimating the depth to the groundwater;
measuring the extent and location of the release (in accordance with an approved
QAPP);
storing excavated contaminated materials in a manner that prevents further migration
of contaminants (follow stockpiling guidelines);
Enclosed is a Site Assessment/Release Investigation Summary Form to further assist you in
conducting work and reporting the required information. A site assessment/release investigation
report must be submitted within 30 days of discovery of a release. The department may grant 14 day
extensions, if requested and determined necessary.
In addition, upon confirmation of a petroleum release, the owner or operator of the UST must
undertake Corrective Action in accordance with 18 AAC 78.240. Corrective Action includes, at a
minimum, the following:
Mr. Jerome Selby -3- October 25, 1993
I
determining the nature and amount of the release;
conducting a preliminary risk evaluation (see enclosed form);
determining the full extent and location of soils contaminated by the release;
—� determining the presence and concentration of dissolved contamination in the ground
water;
removing free product (if present) from soils and ground water;
treating or removing contaminated soil and ground water; and
treating and/or disposing of contaminated cleanup materials, including soil and/or
water removed from the area affected by the release. Treatment and/or disposal of
cleanup materials must be conducted with prior approval from the Department.
The UST regulations require submittal of an interim corrective action report, preliminary risk
evaluation form and a free product recovery report within sixty (60) days of identifying a release.
Again, the department may grant extensions on a case by case basis, if determined necessary.
Based on the information that will be submitted, the Department may request additional information
and/or work plans which are determined necessary to respond to this release.
Enclosed are copies of a Preliminary Risk Evaluation Form, a Site Assessment/ Release Investigation
Summary Form, UST closure and cleanup grant applications (financial assistance), a list of firms with
licensed UST workers and firms with approved QAPPs and guidance for selecting a contractor and
consultant to help you address this release.
Please note that the collection of field data and submittal of reports must be conducted by, or
supervised by a qualified, impartial, third party with an approved Quality Assurance Program
Plan (QAPP) on file with the Department (a list of firms with approved QAPPs is enclosed). The
requirement for an impartial third party may be waived by the Department if:
1) It is documented that a qualified, objective, person will conduct the work.
2) The Department reviews and approves the documentation pertaining to "qualified" and
"objective" prior to initiation of the field work.
In addition, please note that according to 18 AAC 78.400, no person may conduct and no owner or
operator may allow to be conducted any part of an UST installation, repair, reconfiguration, closure,
tank tightness test or cathodic protection test unless the person conducting the test is certified by the
state or is directly supervised by someone who is certified and that supervisor inspects the work and
approves the work in writing.
Mr. Jerome Selby -4-
October 25, 1993
Please note if you intend to apply for financial assistance, as provided for by AS 46.03.410, please
forward completed assistance applications and copies of all work plans and reports to the UST
financial assistance program, 3601 C Street, Suite 398, Anchorage, Alaska 99503.
You will help satisfy both state and federal regulations by following the requirements outlined above.
If you have any questions, please do not hesitate to contact me at 563-6529.
Also, please note that these UST have not yet been registered with the Department. Based on the
information, available, it appears that completion of the enclosed registration form will help satisfy
this requirement. If you have any questions on this form, please contact Linda Neuchterlein at the
phone number at the bottom of the form. This form should be submitted to the address at the bottom
of the form.
Please include the facility name, facility ID number and the spill number as shown at the top of this
letter in all future correspondence. Please submit reports to me at the address below:
Sincerely,
W`(2, C_�_'�
Kent Patrick -Riley
UST/LUST Program, SCRO
KPR:el
cc: Don Fritz
Bonnie Friedman, UST Financial Assistance Program, ADEC
Linda Neuchterlein
Bill Reith, Kodiak Field Office
Ray Dronnenburg, WDO
Robert Trousil, E.viroo .W E.&.,. Kodiak Mand Borough, 710 Mill Bay Road Kodiak. AK 99615; Aan: Eoginoennc Facilifi c
Acti.: NORL. ADD
Enclosures:
■ Site assessment/release investigation summary form
■ Preliminary risk evaluation form
■ Firms with licensed ust workers and firms with approved qapps
■ Tank upgrade and closure application
■ Tank cleanup grant and loan application
■ Selecting a firm to conduct cleanups & site investigations
■ Registration form
1.) 4p&oEek_u..
Kodiak Island Borough
Request For Quotation
Removal of Underground Storage Tank
FAX #4b� - Z 10/
The Kodiak Island Borough requests that your company submit a price quote to remove one
(1) underground heating oil storage tank located at the Kodiak Island Borough Building.
Fuel oil has been removed from the tank which had contained #2 diesel.
Your immediate response is requested.
The Kodiak Island Borough has identified the following elements as the basis for the price
quotation:
1. State Certified UST Supervisor
2. Field technician/crew
3. Excavation work
4. UST monitoring and Soil Sampling
5. Inertion Gas (for tank)
6. Removal and Transport of Tank to KIB Landfill
7. Removal and Transport of up to 50 cubic yards of Contaminated Soil
8. supply 30'x30' 24 mill pit liner
9. supply 30'x30' 12 mill cover liner
10. Data Evaluation and Final UST Removal Report
Please submit written and faxed price quotes by 12:00 noon, November 1, 1993. Award of
the work will be based on lowest bid received, however, the Kodiak Island Borough reserves
the right to reject or accept any or all quotations, to waive any irregularities or informalities
in the quotation and to give particular attention to the qualifications of the contractor. Please
indicate availability to begin work immediately.
If you have any questions or require additional information, please do not hesitate to contact
Robert Trousil at 486-9341 or 486-9376 (fax). Thank you.
Dated October 29, 1993
Kodiak Island Borough
Engineering/Facilities Dept.
Island Environmental Services
P.O. Box 3227
Kodiak, Alaska 99615
Bob Trousil
Environmental Engineer
Kodiak Island Borough
710 Mill Bay Road
Kodiak, AK 99615-6340
19 -Oct -93
RE: Tank closure.
Dear Bob:
The following is a cost estimate for performing a UST closure on the Borough's 5,000 gallon heating oil tank
located at the KIB office building which is suspected of leaking.
COST ESTIMATE
A.)
State Certified UST Supervisor
$1,280.00
B.)
I.E.S. Technician
$752.00
C.)
Excavation Work
$4,644.00
D.)
UST Monitoring & Soil Sampling
$2,909.00
E.)
Data Evaluation & Final Report
$2,539.00
F.)
Inertion Gas
$150.00
G.)
30'x30' Pit Liner 24 mill
$389.00
H.)
30'x30' Pit Cover 12 mill
$243.00
COST ESTIMATE TOTAL $12,906.00
This cost estimate was calculated on the bases that some contamination would be found in the tank pit and would
need to be transferred to the KIB land fill for storage, and that the 5,000 gallon tank would also be transported to
the land fill which would be used for holding waste oil or be cut up at a later date.
Thank you for considering Island Environmental Services in this and future projects.
Sincerely,
Richard H. Walker
Manager
Page 2
Kodiak Island Borough
Request For Quotation
Removal of Underground Storage Tank
TO
FAX #4 Z� 5
The Kodiak Island Borough requests that your company submit a price quote to remove one
(1) underground heating oil storage tank located at the Kodiak Island Borough Building.
Fuel oil has been removed from the tank which had contained #2 diesel.
Your immediate response is requested.
The Kodiak Island Borough has identified the following elements as the basis for the price
quotation:
1. State Certified UST Supervisor
2. Field technician/crew
3. Excavation work
4. UST monitoring and Soil Sampling
5. Inertion Gas (for tank)
6. Removal and Transport of Tank to KIB Landfill
7. Removal and Transport of up to 50 cubic yards of Contaminated Soil
8. Supply 30'x30' 24 mill pit liner
9. Supply 30'x30' 12 mill cover liner
10. Data Evaluation and Final UST Removal Report
Please submit written and/or faxed price quotes by 12:00 noon, November 1, 1993. Award
of the work will be based on lowest bid received, however, the Kodiak Island Borough
reserves the right to reject or accept any or all quotations, to waive any irregularities or
informalities in the quotation and to give particular attention to the qualifications of the
contractor. Please indicate availability to begin work immediately.
If you have any questions or require additional information, please do not hesitate to contact
Robert Trousil at 486-9341 or 486-9376 (fax). Thank you.
Dated October 29, 1993
Kodiak Island Borough
Engineering/Facilities Dept.
FROM
TELEPHONE .._._._.'..i`..!-�� 4--------'
PROPOSAL
NUMBER
DATE
_. SHEET NO _..... - — -OF..
- j
ARCHITECT
DATE OE PLANS
..7 g OST
RSvlL_OlnJl�
WORK TO BE PERFORMED AT snsmn srnrr "'"--
We propose to furnish all the materials and perform all the labor necessary for the completion of
6. i-49-wliL
_Zq 49
i
All material is guaranteed no be as specified, and the above work to be performed in accordance with the drawings
and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of
lS__
with payments to be, made as follows:
Any alteration or deviation from above specifications involving extra
costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent
upon strikes, accidents ar delays beyond our control. Owner to carry
fire, tornado and other necessary insurance upon above work. Respectfully Submitted f !�
Workmen's Comperssarion and Public liability Insurance on above
work taken out by
For
NOTE: This prtiposal may be withdrawn'by'us if not accepted withindays.
ACCEPTANCE
OF PROPOSAL
The above prices, specifications and
conditions are satisfactory and are
hereby accepted. You are authorized to
,To the work a3 tptfifiyA. Payment will
be made as nutlined above.
ORIGINAL
Signature
Certified UST Installers
Western Mechanical, Inc.
PO Box 66067
Fairbanks,nv 99706
_. ��
(907) 452-1831
Southeast Alaska
Arrowhead Transfer
PO Box 177
Sitka, AK 99835
(907) 747-8647
Marion Hobbs Construction
PO Box 210447
Auke Bay, AK 99821
(907) 789-5952
Petroleum Services, Inc.
PO Box 32437
Juneau, AK 99803
(907) 789-1918
Southeast Engineering
PO Box 8278
Ketchikan, AK 99901
(907) 225-6513
Kenai Pennisula
Chumley's Inc.
PO Box 753
Sterling, AK 99672
(907) 262-4668
Jackson Construction
241 Aspen
Soldotna, AK 99669
(907) 262-4485
Kodiak
A -K Construction
PO Box 886
Kodiak, AK 99615
(907) 487-4400
Kodiak Tank Service
PO Box 979
Kodiak, AK 99615
(907) 486-5216
Michael Desmond
Brad Erichson
Len Riley
Marion Hobbs
John Bertholl
Jerry Godkin
Richard Ipsen
Brian Jones
George Lybrand
Donald McCloud
Harold Jackson
John Mills
C.F. Lottsfeldt
June 2, 1993
Certified UST Installers
Island Environmental Services
PO Box 3227
Kodiak, AK 99615
(907) 486-8351
Mat -Su Valley
Brown and Root Services Corp.
411 Jerome Drive
Wasilla, AK 99654
(907) 428-2241
Eagle Contracting Corp
PO Box 1125
Willow, AK 99688
Hermon Brothers Construction
111 West El mond
Palmer, AK 99645
(907) 745-3249
New Horizons
PO Box 2049
Palmer, AK 99645
(907) 746-6022
Delta Junction - Tok
Delta Fuel, Inc.
PO Box 807
Delta Junction, AK 99737
(907) 895-4887
Marunde & Sons
PO Box 192
Tok, AK 99780
(907) 883-4601
Nistler Enterprises
PO Box 952
Delta Junction, AK 99737
(907)895-4550
Petroleum Services
PO Box 165
Tok, AK 99780
(907) 883-5833
Richard Walker
Herb Dunham
Mike Sandstrom
Ben Hermon
Jon Shepherd
Darrell Lankford
John Lee
Mark Ogle
Dave Zimmerman
David Webber
Glen Marunde
David Johnson
James Heral
Roger Harris
Myron Bearson
June 2, 1993
Certified UST Workers for Closure
_- Paid'c GatiirPg __ Gerald Smens_
PO Box 182
Anchor Point, AK 99556
(907) 2354443
Rozak Engineering
36635 Chinula Drive
Kenai, AK 99611
(907) 283-5640
Rozak Excavating & Construction
PO Box 710
Kasilof, AK 99610
(907) 262-4218
Kodiak
A -K Construction
PO Box 886
Kodiak, AK 99615
(907) 487400
Kodiak Tank Service
PO Box 979
Kodiak, AK 99615
(907) 486-5216
Island Environmental Services
PO Box 3227
Kodiak, AK 99615
(907) 486-8351
Mat -Su Valley
American Realty Company
PO Box 872603
Wasilla, AK 99687
(907) 376-6868
Brown and Root Services Corp.
411 Jerome Drive
Wasilla, AK 99654
Eagle Contracting Corp.
PO Box 1125
Willow, AK 99688
Fisher Fuels, Inc.
PO Box 520209
Big Lake, AK 99652
(907) 892-6359
Ron Rozak
David Inabnit
Greg Rozak
John Mills
C.F. Lottsfeldt
Richard Walker
Wesley Allen
Herb Dunham
Mike Sandstrom
Brad Fisher
June 2, 1993
KODIAK ISLAND BOROUGH
CONTRACT CHANGE ORDER
710 MILL BAY ROAD
KODIAK, ALASKA 99615
Contract No.
9 3 — 9 Change Order No.
Project Name, Number & Location
Amount of Contract & Change Orders
ci c�nc _ 15 Remc=v..l —:r 4 a
Original Contract a :; - _ • u • ,
Previous Changes
Contractor
This Change
Adjusted Contract
Description of Change
Cost
l;g _ iCC)� L4., ccLlc>=: ]40
_4-A I-
Vi "'i /`
.iU l..l J!!i_ LVCil,l•
.. ..,1d`t C+U� :;OL..•E'il'._ C:i,:.ce1��.31:;.
li_3 0,1i iC �6:�li �. .. [li.ziiL:ij
7. i Ulu ` t (: ..1y i c_ u1) - calci .nl 03: alt::
-3 U!_ J01 H.r:'.:� iJUCTllt dLC. d U:.i.
"!-: C"i.Ui. biC it ll': !i+liii ll..
c:i t: a Vr.a rel La
L:COu('-n c.'11 i.il,;)%
11.
,. _:1uo J Lt L:'1: 1_
i.-U Lc%.i. '._. U(
i •l. q� -,. -. � - � :i
._lu.Cr..... 1.. �-l1 :. :,f Llri U1. ♦. 1.1; C: C!. t,l ai A3ci G. i..
(_1U 411 C�.G.iA. a i. l: Jiri
__.e
yl J_1:. 11.1 :'
The time provided for completion of the contract is (unchanged):#waw*. (d w) by a calendar days. This document shall
become an amendment to the contract and all provisions of the contract will apply thereto
Accepted By:
Date
`Contractor's Representative
Recommended: �� fit. i
Date
Fac0itylCoordi0alor
Approved By:
Date
Contracting Officer
T
Copies: Original to Facility Coordinator
Canary to Contractor
Pink to Project Inspector