Source Removal QuoteSummary Form by owm23003

VIEWS: 11 PAGES: 4

									                                                                          Florida Department of Environmental Protection-Division of Waste Management-Bureau of Petroleum Storage Systems


                                                                                  Petroleum Cleanup Preapproval Program
                                                                                              Source Removal Quote / Summary Form



     FDEP Preapproval Contractor: _______________________________________________________                                                                                                           Key : l.s. = Lump Sum
     Facility Name: __________________________________________________________                                                                                                                           s.f. = Square Foot
     Facility ID#: __________________________                                                                                                                                                            c.y. = Cubic Yard
     Tank Removal / Upgrade: YES or NO                                                                                                                                                                   l.f. = Linear Foot
     Total Volume To Be Excavated: ___________________ (cubic yards)


                                                                                                                                                              UNIT COSTS                                                                 DEP USE ONLY
     DESCRIPTION
     (all categories include labor, fuel, mob/demob, per diem, equipment & expendables)                                          IN-HOUSE          SUB UNIT          IN-HOUSE                            SUB ID                       WORK ORDER    EVENT
                                                                                                       QTY.        UNIT          UNIT COST          COST             SUBTOTAL         SUB SUBTOTAL         #            TOTAL           NUMBER     NUMBER
     Permitting Cost
   Permit (specify type) :________________________ (This item is for actual permit costs
   only. Costs associated with pulling permits (labor, etc.) should not be included in the                                                                              $0.00               $0.00
 1 unit rate for this item and should be included in item #2)                                                      each                                                                                                       $0.00
 2 Other Permit Costs (This item is for costs associated with pulling permits (labor, etc.)                        each                                                 $0.00               $0.00                             $0.00
     Sub-Total Permitting Cost                                                                                                                                          $0.00               $0.00                             $0.00
     Activities
 3 Asphalt and/or Concrete Removal                                                                                  s.f.                                                $0.00               $0.00                             $0.00
 4 Asphalt and/or Concrete Transportation & Disposal                                                                ton                                                 $0.00               $0.00                             $0.00
     Conventional Soil Excavation (total depth ≤ 20 feet) (conversion factor for tonnage: 1.4)
 5 (includes loading of excavated soils and install/compact backfill material)                                     c.y.                                                 $0.00               $0.00                             $0.00
   Conventional Soil Excavation (total depth > 20 feet) (conversion factor for tonnage: 1.4)
 6 (includes loading of excavated soils and install/compact backfill material)                                     c.y.                                                 $0.00               $0.00                             $0.00
 7   Sheet Piling (specify wall depth: __________ feet)                                                           per l.f.                                              $0.00               $0.00                             $0.00
 8   Large Diameter Auger Excavation Without Casing (auger dia.: ____ feet) (includes loading)                     c.y.                                                 $0.00               $0.00                             $0.00
 9   Large Diameter Auger Excavation With Casing (auger dia.: ____ feet) (includes loading)                        c.y.                                                 $0.00               $0.00                             $0.00
10   Flowable Fill Concrete
        (psi: _______)                                                                                             c.y.                                                 $0.00               $0.00                             $0.00
        (psi: _______)                                                                                             c.y.                                                 $0.00               $0.00                             $0.00
11 Stormwater / Erosion Control                                                                                    l.s.                                                 $0.00               $0.00                             $0.00
        (specify type): ________________________________
12 Compaction Testing                                                                                               l.s.                                                $0.00               $0.00                             $0.00
13 Backfill Material (includes transport) (specify type of clean fill) :___________________                        c.y.                                                 $0.00               $0.00                             $0.00
14 Transport - Impacted Soil                                                                                       ton                                                  $0.00               $0.00                             $0.00
15 Disposal - Impacted Soil (landfill)                                                                              ton                                                 $0.00               $0.00                             $0.00
16   Disposal - Impacted Soil (thermal treatment)                                                                   ton                                                 $0.00               $0.00                             $0.00
17   Disposal - Impacted Soil (other) (specify type) :________________                                              ton                                                 $0.00               $0.00                             $0.00
18   Transport - Clean Overburden                                                                                   ton                                                 $0.00               $0.00                             $0.00
19   Disposal - Clean Overburden (specify disposal method) :_____________                                           ton                                                 $0.00               $0.00                             $0.00
     Petroleum Storage System Removal and Disposal (includes vapor evacuating, sludge
20 removal, cleaning, etc.)
        Tank Volume 1 (gal): __________       # of Tanks: _________      AST or UST: ____________                  tank                                                 $0.00               $0.00                             $0.00
        Tank Volume 2 (gal): __________       # of Tanks: _________      AST or UST: ____________                  tank                                                 $0.00               $0.00                             $0.00
        Tank Volume 3 (gal): __________       # of Tanks: _________      AST or UST: ____________                  tank                                                 $0.00               $0.00                             $0.00
        Tank Volume 4 (gal): __________       # of Tanks: _________      AST or UST: ____________                 tank                                                  $0.00               $0.00                             $0.00
21 Petroleum Contact Water T&D                                                                                   gallons                                                $0.00               $0.00                             $0.00
          c80f833e-5010-43be-9134-08f96b2b695e.xls                                                                           Page 1 of 4
                                                                                Florida Department of Environmental Protection-Division of Waste Management-Bureau of Petroleum Storage Systems


                                                                                        Petroleum Cleanup Preapproval Program
                                                                                                   Source Removal Quote / Summary Form



     FDEP Preapproval Contractor: _______________________________________________________                                                                                                                 Key : l.s. = Lump Sum
     Facility Name: __________________________________________________________                                                                                                                                 s.f. = Square Foot
     Facility ID#: __________________________                                                                                                                                                                  c.y. = Cubic Yard
     Tank Removal / Upgrade: YES or NO                                                                                                                                                                         l.f. = Linear Foot
     Total Volume To Be Excavated: ___________________ (cubic yards)
                                                                                                                                                                      UNIT COSTS                                                               DEP USE ONLY
     DESCRIPTION
     (all categories include labor, fuel, mob/demob, per diem and equipment)                                                                                                                                                                              EVENT
                                                                                                                                     IN-HOUSE              SUB UNIT        IN-HOUSE                            SUB ID                       WORK ORDER
                                                                                                             QTY.        UNIT        UNIT COST              COST           SUBTOTAL         SUB SUBTOTAL         #            TOTAL           NUMBER     NUMBER
22 Product Transport & Disposal                                                                                        gallons                                                $0.00               $0.00                             $0.00
23 1Petroleum Storage System Installation
          Tank Volume 1 (gal): __________         # of Tanks: _________       AST or UST: ____________                   tank                                                 $0.00               $0.00                             $0.00
          Tank Volume 2 (gal): __________         # of Tanks: _________       AST or UST: ____________                   tank                                                 $0.00               $0.00                             $0.00
          Tank Volume 3 (gal): __________         # of Tanks: _________       AST or UST: ____________                   tank                                                 $0.00               $0.00                             $0.00
          Number of Dispensers: __________                                                                            dispenser                                               $0.00               $0.00                             $0.00
24 Site Paving - Asphalt (includes sub-base) (thickness: _________ inches)                                                s.f.                                                $0.00               $0.00                             $0.00
25 Site Paving - Concrete
           (psi: _______; thickness: ______ inches)                                                                       s.f.                                                $0.00               $0.00                             $0.00
           (psi: _______; thickness: ______ inches)                                                                       s.f.                                                $0.00               $0.00                             $0.00
           (psi: _______; thickness: ______ inches)                                                                       s.f.                                                $0.00               $0.00                             $0.00
26 Sod                                                                                                                    s.f.                                                $0.00               $0.00                             $0.00
27   Seed & Mulch (includes tacking)                                                                                     s.f.                                                 $0.00               $0.00                             $0.00
28   Safety Devices (barricades, lights, signs, concrete barriers, trench boxes & plates)                                l.s.                                                 $0.00               $0.00                             $0.00
29   Security Fencing                                                                                                    l.f.                                                 $0.00               $0.00                             $0.00
30   Dewatering System (specify # of points: _____ ) (system type) ______________                                    day/wk/mth                                               $0.00               $0.00                             $0.00
          (extended rate: _________ daily / weekly)
31 Onsite Treatment System (specify maximum influent capacity: ________ gal/min)                                     day/wk/mth                                               $0.00               $0.00                             $0.00
          (extended rate: _________ daily / weekly)
          (includes setup, operation, monitoring and removal of system)
32 Holding Tank (specify tank size: ___________ gallons)                                                             day/wk/mth                                               $0.00               $0.00                             $0.00
          (extended rate: _________ daily / weekly)
33 Other (specify type and units)                                                                                                                                             $0.00               $0.00                             $0.00
34 Other (specify type and units)                                                                                                                                             $0.00               $0.00                             $0.00
35 Other (specify type and units)                                                                                                                                             $0.00               $0.00                             $0.00
36 Other (specify type and units)                                                                                                                                             $0.00               $0.00                             $0.00
     Sub-Total Activities Cost                                                                                                                                                $0.00               $0.00                             $0.00
     PROJECT TOTAL                                                                                                                                                            $0.00               $0.00                             $0.00
     1
         Costs included in this activity shall account for labor only. No costs shall be included for hardware (tanks, product lines, dispensers, etc.).




             c80f833e-5010-43be-9134-08f96b2b695e.xls                                                                            Page 2 of 4
                                                                          Florida Department of Environmental Protection-Division of Waste Management-Bureau of Petroleum Storage Systems


                                                                                  Petroleum Cleanup Preapproval Program
                                                                                              Source Removal Quote / Summary Form



FDEP Preapproval Contractor: _______________________________________________________                                                                                                              Key : l.s. = Lump Sum
Facility Name: __________________________________________________________                                                                                                                               s.f. = Square Foot
Facility ID#: __________________________                                                                                                                                                                c.y. = Cubic Yard
Tank Removal / Upgrade: YES or NO                                                                                                                                                                       l.f. = Linear Foot
Total Volume To Be Excavated: ___________________ (cubic yards)

Days to Complete Scope of Work:                                                                                                                                   Project No.

Prime Contractor/Subcontractor Company Name:

Prime Contractor/Subcontractor Mailing Address:


Name, Title and Signature of Person Submitting Quote:                                                                                                                                 Date:




Impacted Soil Destination (facility name & address) :

2
    Soil Laboratory Analysis Requirements:


Petroleum Contact Water Destination (facility name & address) :                                                                                                   Disposal Method:

PCW Laboratory Analysis Requirements:

Free Product Destination (facility name & address) :                                                                                                              Disposal Method:

Free Product Laboratory Analysis Requirements:


Asphalt/Concrete Debris Destination (facility name & address) :                                                                                                   Disposal Method:

Tank Debris Destination (facility name & address) :

3
    Backfill Supplier (facility name & address):



2
    Analytical requirements to be supplied if different from Chapter 62-713, F.A.C requirements. Request must be supported by written statement from treatment/disposal facility.
3
    Specify approved backfill supplier, or state that the backfill supplier will be sampled, and the Backfill Project Soil Analysis Form will be forwarded to Team 5 upon receipt of lab analyticals.




        c80f833e-5010-43be-9134-08f96b2b695e.xls                                                                          Page 3 of 4
                                                          Florida Department of Environmental Protection-Division of Waste Management-Bureau of Petroleum Storage Systems


                                                                   Petroleum Cleanup Preapproval Program
                                                                              Source Removal Quote / Summary Form



FDEP Preapproval Contractor: _______________________________________________________                                                                                        Key : l.s. = Lump Sum
Facility Name: __________________________________________________________                                                                                                        s.f. = Square Foot
Facility ID#: __________________________                                                                                                                                         c.y. = Cubic Yard
Tank Removal / Upgrade: YES or NO                                                                                                                                                l.f. = Linear Foot
Total Volume To Be Excavated: ___________________ (cubic yards)


                                                                                    SUBCONTRACTOR SUMMARY

Entries on this sheet DO NOT populate templates
                                                                  SUBCONTRACT
   SUB ID #                  SUBCONTRACTOR NAME                     OR TOTAL                                                                 COMMENTS




                                                         Total        $0.00




    c80f833e-5010-43be-9134-08f96b2b695e.xls                                                              Page 4 of 4

								
To top