Invoice Oil Change

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					                      PETROLEUM STORAGE TANK FUND
                        INSTRUCTIONS FOR INVOICE
                             REVISED 12/30/08
The standardized invoice format must be utilized for all applications to the
Division of Oil and Public Safety (OPS) submitted after 6/30/09. Only eligible
costs will be considered for reimbursement from the Petroleum Storage Tank


                                     INSTRUCTIONS
1. PURPOSE

The purpose of the revised invoice is to allow for standardized submittals, accurate
coding and streamlined reviews of all costs submitted. This invoice format will
replace all other invoice formats.

2. STRUCTURE

The invoice form contains Phase of Work Codes (PWC) and allowable Activity Codes (AC)
listed below each PWC.
Click here to link to 2002 and 2009 RCGs and the Task/Labor Codes per Activity.

The TLCs for work done prior to 2002 are listed on our Web page under the Fund Section.

3. PROCEDURE


When completing the invoice, each cost must include a code from all of the three
categories (PWC, AC, TLC). Do not combine PWCs, ACs or TLCs. Each cost
must be listed in its individual cell on the form. Select only from those ACs listed
under a particular PWC on the invoice form. The 2002 and 2009 TLCs are in the
same format as the invoice format (including cell formulas) and can be copied and
pasted directly into the invoice from under the appropriate AC.

If the work on a line item was performed by a subcontractor, please provide the
name and invoice number of the corresponding subcontractor's invoice in the task
description field.


If you are not requesting reimbursement for costs under a PWC then delete all rows
corresponding to that section including the corresponding line in the PWC
summary at the bottom of the invoice.
If the work on a line item is coded 5.4 and above for labor, please provide the
individual's Listed Consultant in the Task Description field, if applicable.

If you have any questions on how to code application preparation costs, see
Question #14 on our Web page under the Remediation Section under Remediation
Section FAQ's for the eRAP or Cost Reimbursement.

NOTE: Costs submitted for reimbursement in the eRAP (EFS) process cannot be
submitted in same application as POW 1 and 2.
                                                                                                                                                                                                                                                                                                        Page Number 3
                                                                                                                        OPS INVOICE FORMAT
                                 Client Name:                                                                                                                                                                          Invoice#:




                                                                                                                                                                                                                                                                                   DO NOT ADD ANY EXTRA COLUMNS!
                             Billing Address:                                                                                                                                                                      Invoice date:
                             City, State, Zip:                                                                                                                                                                             Page:
                                   Site Name:                                                                                                                                                                              Job#:
                                Site Address:                                                                                                                                                               Consultant Listing #:
                             City, State, Zip:
                                      Event #:                                                                                            Start Date:                                                              End Date:
Note delete any rows on the invoice that are not being requested for reimbursement
  PHASE OF WORK CODE (PWC)




                                                                                                                                                                                                                      SUBTOTAL BY ACTIVITY AND
                                                            TASK OR LABOR CODE (TLC)




                                                                                                                                              UNIT RATE REQUESTED




                                                                                                                                                                    SUBTOTAL REQUESTED




                                                                                                                                                                                         MARKUP REQUESTED
                                     ACTIVITY CODE (AC)




                                                                                                  TASK DESCRIPTION




                                                                                                                                                                                                                                                         TOTAL REQUESTED
                                                                                                                                              REIMBURSEMENT




                                                                                                                                                                    REIMBURSEMENT




                                                                                                                                                                                         REIMBURSEMENT




                                                                                                                                                                                                                                                         REIMBURSEMENT
                                                                                                                                                                                                                      TASK GROUP
                                                                                                                               QUANTITY
                                                                                                                       UNITS



  1A                         Contaminated soil excavation oversight & sampling
                                    i.        Data review & reporting
                                                                                                                                                                                                                                                     $                         -


                                                                                       Activity Code i. Subtotal                                                                                               $                                 -
                                        l.                Excavation


                                                                                       Activity Code l. Subtotal                                                                                               $                                 -
                                                                                                                                                                    TOTAL 1A COSTS:                                                                  $                     -


  1B                         Emergency response oversight & sampling
                                   g.       Monitoring plan implementation


                                                                                       Activity Code g. Subtotal                                                                                               $                                 -
                                        i.                Data review & reporting


                                                                                       Activity Code i. Subtotal                                                                                               $                                 -
                                        j.                Direct push


                                                                                       Activity Code j. Subtotal                                                                                               $                                 -
                                     k.                   Drilling                                                   Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                               $                                 -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                               $                                 -
                                                                                                                                                                    TOTAL 1B COSTS:                                                                  $                     -


  1C                         Free-product/contaminated groundwater removal
                                    a.        Pilot and/or aquifer test



                                                                                       Activity Code a. Subtotal                                                                                               $                                 -
                                     b.                   System design


                                                                                       Activity Code b. Subtotal                                                                                               $                                 -
                                     d.                   System installation



                                                                                       Activity Code d. Subtotal                                                                                               $                                 -
                                     e.                   System startup



                                                                                       Activity Code e. Subtotal                                                                                               $                                 -
                                       f.                 System O&M



                                                                                       Activity Code f. Subtotal                                                                                               $                                 -
                                     g.                   Monitoring plan implementation



                                                                                       Activity Code g. Subtotal                                                                                               $                                 -
                                        i.                Data review & reporting



                                                                                       Activity Code i. Subtotal                                                                                               $                                 -
                                        j.                Direct push



                                                                                       Activity Code j. Subtotal                                                                                               $                                 -
                                     k.                   Drilling                                                   Number of wells:



                                                                                       Activity Code k. Subtotal                                                                                               $                                 -
                                                                                                                                                                                                                                                                                                      Page Number 4
                                                                                                                         OPS INVOICE FORMAT
                                 Client Name:                                                                                                                                                                            Invoice#:




                                                                                                                                                                                                                                                                                 DO NOT ADD ANY EXTRA COLUMNS!
                             Billing Address:                                                                                                                                                                        Invoice date:
                             City, State, Zip:                                                                                                                                                                               Page:
                                   Site Name:                                                                                                                                                                                Job#:
                                Site Address:                                                                                                                                                                 Consultant Listing #:
                             City, State, Zip:
                                      Event #:                                                                                              Start Date:                                                              End Date:
Note delete any rows on the invoice that are not being requested for reimbursement
  PHASE OF WORK CODE (PWC)




                                                                                                                                                                                                                        SUBTOTAL BY ACTIVITY AND
                                                            TASK OR LABOR CODE (TLC)




                                                                                                                                                UNIT RATE REQUESTED




                                                                                                                                                                      SUBTOTAL REQUESTED




                                                                                                                                                                                           MARKUP REQUESTED
                                     ACTIVITY CODE (AC)




                                                                                                  TASK DESCRIPTION




                                                                                                                                                                                                                                                           TOTAL REQUESTED
                                                                                                                                                REIMBURSEMENT




                                                                                                                                                                      REIMBURSEMENT




                                                                                                                                                                                           REIMBURSEMENT




                                                                                                                                                                                                                                                           REIMBURSEMENT
                                                                                                                                                                                                                        TASK GROUP
                                                                                                                                 QUANTITY
                                                                                                                        UNITS



                                    m.                    Trenching                                                  Linear feet of trench:


                                                                                       Activity Code m. Subtotal                                                                                                 $                                 -
                                     n.                   System enclosure


                                                                                       Activity Code n. Subtotal                                                                                                 $                                 -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 1C COSTS:                                                                  $                     -


  2A                         Drilling & direct push
                                        j.                Direct push



                                                                                       Activity Code j. Subtotal                                                                                                 $                                 -
                                     k.                   Drilling                                                   Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 2A COSTS:                                                                  $                     -


  2B                         Groundwater monitoring (well sampling & groundwater measurement)
                                   g.       Monitoring plan implementation



                                                                                       Activity Code g. Subtotal                                                                                                 $                                 -
                                        i.                Data review & reporting



                                                                                       Activity Code i. Subtotal                                                                                                 $                                 -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 2B COSTS:                                                                  $                     -


  2C                         SCR report preparation
                                    i.        Data review & reporting



                                                                                       Activity Code i. Subtotal                                                                                                 $                                 -
                                     p.                   Modeling



                                                                                       Activity Code p. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 2C COSTS:                                                                  $                     -
  2D                         Additional data collection (survey, soil samples, etc.)
                                     a.        Pilot and/or aquifer test



                                                                                       Activity Code a. Subtotal                                                                                                 $                                 -
                                     g.                   Monitoring plan implementation


                                                                                       Activity Code g. Subtotal                                                                                                 $                                 -
                                        i.                Data review & reporting


                                                                                       Activity Code i. Subtotal                                                                                                 $                                 -
                                        j.                Direct push


                                                                                       Activity Code j. Subtotal                                                                                                 $                                 -
                                     k.                   Drilling                                                   Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                                 $                                 -
                                        l.                Excavation
                                                                                                                                                                                                                                                                                                      Page Number 5
                                                                                                                         OPS INVOICE FORMAT
                                 Client Name:                                                                                                                                                                            Invoice#:




                                                                                                                                                                                                                                                                                 DO NOT ADD ANY EXTRA COLUMNS!
                             Billing Address:                                                                                                                                                                        Invoice date:
                             City, State, Zip:                                                                                                                                                                               Page:
                                   Site Name:                                                                                                                                                                                Job#:
                                Site Address:                                                                                                                                                                 Consultant Listing #:
                             City, State, Zip:
                                      Event #:                                                                                              Start Date:                                                              End Date:
Note delete any rows on the invoice that are not being requested for reimbursement
  PHASE OF WORK CODE (PWC)




                                                                                                                                                                                                                        SUBTOTAL BY ACTIVITY AND
                                                            TASK OR LABOR CODE (TLC)




                                                                                                                                                UNIT RATE REQUESTED




                                                                                                                                                                      SUBTOTAL REQUESTED




                                                                                                                                                                                           MARKUP REQUESTED
                                     ACTIVITY CODE (AC)




                                                                                                  TASK DESCRIPTION




                                                                                                                                                                                                                                                           TOTAL REQUESTED
                                                                                                                                                REIMBURSEMENT




                                                                                                                                                                      REIMBURSEMENT




                                                                                                                                                                                           REIMBURSEMENT




                                                                                                                                                                                                                                                           REIMBURSEMENT
                                                                                                                                                                                                                        TASK GROUP
                                                                                                                                 QUANTITY
                                                                                                                        UNITS




                                                                                       Activity Code l. Subtotal                                                                                                 $                                 -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                                 $                                 -
                                     p.                   Modeling



                                                                                       Activity Code p. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 2D COSTS:                                                                  $                     -


  3A                         Pilot tests & pumping/slug tests
                                      a.       Pilot and/or aquifer test



                                                                                       Activity Code a. Subtotal                                                                                                 $                                 -
                                        j.                Direct push


                                                                                       Activity Code j. Subtotal                                                                                                 $                                 -
                                     k.                   Drilling                                                   Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                                 $                                 -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 3A COSTS:                                                                  $                     -


  3B                         Remediation system design
                                   b.         System design


                                                                                       Activity Code b. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 3B COSTS:                                                                  $                     -


  3C                         CAP report preparation
                                    c.        CAP preparation


                                                                                       Activity Code c. Subtotal                                                                                                 $                                 -
                                     p.                   Modeling


                                                                                       Activity Code p. Subtotal                                                                                                 $                                 -
                                                                                                                                                                      TOTAL 3C COSTS:                                                                  $                     -


  3D                         Remediation system installation/excavation
                                   d.         System installation


                                                                                       Activity Code d. Subtotal                                                                                                 $                                 -
                                        j.                Direct push


                                                                                       Activity Code j. Subtotal                                                                                                 $                                 -
                                     k.                   Drilling                                                   Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                                 $                                 -
                                        l.                Excavation


                                                                                       Activity Code l. Subtotal                                                                                                 $                                 -
                                    m.                    Trenching                                                  Linear feet of trench:


                                                                                       Activity Code m. Subtotal                                                                                                 $                                 -
                                     n.                   System enclosure


                                                                                       Activity Code n. Subtotal                                                                                                 $                                 -
                                                                                                                                                                                                                                                                                                          Page Number 6
                                                                                                                           OPS INVOICE FORMAT
                                 Client Name:                                                                                                                                                                              Invoice#:




                                                                                                                                                                                                                                                                                     DO NOT ADD ANY EXTRA COLUMNS!
                             Billing Address:                                                                                                                                                                          Invoice date:
                             City, State, Zip:                                                                                                                                                                                 Page:
                                   Site Name:                                                                                                                                                                                  Job#:
                                Site Address:                                                                                                                                                                   Consultant Listing #:
                             City, State, Zip:
                                      Event #:                                                                                                Start Date:                                                              End Date:
Note delete any rows on the invoice that are not being requested for reimbursement
  PHASE OF WORK CODE (PWC)




                                                                                                                                                                                                                          SUBTOTAL BY ACTIVITY AND
                                                            TASK OR LABOR CODE (TLC)




                                                                                                                                                  UNIT RATE REQUESTED




                                                                                                                                                                        SUBTOTAL REQUESTED




                                                                                                                                                                                             MARKUP REQUESTED
                                     ACTIVITY CODE (AC)




                                                                                                  TASK DESCRIPTION




                                                                                                                                                                                                                                                               TOTAL REQUESTED
                                                                                                                                                  REIMBURSEMENT




                                                                                                                                                                        REIMBURSEMENT




                                                                                                                                                                                             REIMBURSEMENT




                                                                                                                                                                                                                                                               REIMBURSEMENT
                                                                                                                                                                                                                          TASK GROUP
                                                                                                                                   QUANTITY
                                                                                                                          UNITS




                                                                                                                                                                        TOTAL 3D COSTS:                                                                    $                     -


  3E                         Remediation system startup & implementation report
                                   e.         System startup


                                                                                       Activity Code e. Subtotal                                                                                                   $                                   -
                                        i.                Data review & reporting


                                                                                       Activity Code i. Subtotal                                                                                                   $                                   -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                                   $                                   -
                                                                                                                                                                        TOTAL 3E COSTS:                                                                    $                     -


  3F                         Remediation system operation & maintenance
                                   f.         System O & M


                                                                                       Activity Code f. Subtotal                                                                                                   $                                   -
                                                                                                                                                                        TOTAL 3F COSTS:                                                                    $                     -


 3G                          Monitoring plan implementation & report preparation
                                    g.         Monitoring plan implementation


                                                                                       Activity Code g. Subtotal                                                                                                   $                                   -
                                        i.                Data review & reporting


                                                                                       Activity Code i. Subtotal                                                                                                   $                                   -
                                        j.                Direct push


                                                                                       Activity Code j. Subtotal                                                                                                   $                                   -
                                     k.                   Drilling                                                     Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                                   $                                   -
                                     o.                   Soil vapor/indoor air sampling


                                                                                       Activity Code o. Subtotal                                                                                                   $                                   -
                                     p.                   Modeling


                                                                                       Activity Code p. Subtotal                                                                                                   $                                   -
                                                                                                                                                                        TOTAL 3G COSTS:                                                                    $                     -


  3H                         Remediation system decommissioning
                                   h.         System decommissioning


                                                                                       Activity Code h. Subtotal                                                                                                   $                                   -
                                        i.                Data review & reporting


                                                                                       Activity Code i. Subtotal                                                                                                   $                                   -
                                     k.                   Drilling                                                     Number of wells:


                                                                                       Activity Code k. Subtotal                                                                                                   $                                   -
                                    m.                    Trenching                                                    Linear feet of trench:


                                                                                       Activity Code m. Subtotal                                                                                                   $                                   -
                                                                                                                                                                        TOTAL 3H COSTS:                                                                    $                     -


                                                                                                                     PHASE OF WORK COST SUMMARY

                                                                                                                                                                                                                                                     INVOICE
                                                                                                                                                                                                                                                                                           Page Number 7
                                                                                                         OPS INVOICE FORMAT
                                 Client Name:                                                                                                                                                           Invoice#:




                                                                                                                                                                                                                                                                      DO NOT ADD ANY EXTRA COLUMNS!
                             Billing Address:                                                                                                                                                       Invoice date:
                             City, State, Zip:                                                                                                                                                              Page:
                                   Site Name:                                                                                                                                                               Job#:
                                Site Address:                                                                                                                                                Consultant Listing #:
                             City, State, Zip:
                                      Event #:                                                                             Start Date:                                                              End Date:
Note delete any rows on the invoice that are not being requested for reimbursement
  PHASE OF WORK CODE (PWC)




                                                                                                                                                                                                       SUBTOTAL BY ACTIVITY AND
                                                          TASK OR LABOR CODE (TLC)




                                                                                                                               UNIT RATE REQUESTED




                                                                                                                                                     SUBTOTAL REQUESTED




                                                                                                                                                                          MARKUP REQUESTED
                                     ACTIVITY CODE (AC)




                                                                                     TASK DESCRIPTION




                                                                                                                                                                                                                                                TOTAL REQUESTED
                                                                                                                               REIMBURSEMENT




                                                                                                                                                     REIMBURSEMENT




                                                                                                                                                                          REIMBURSEMENT




                                                                                                                                                                                                                                                REIMBURSEMENT
                                                                                                                                                                                                       TASK GROUP
                                                                                                                QUANTITY
                                                                                                        UNITS



PHASE OF WORK CODE AND DESCRIPTION                                                                                                                                                                                                TOTAL COSTS
  1A Contaminated soil excavation; oversight & sampling                                                                                                                                         $                                                                 -
  1B  Emergency response; oversight & sampling                                                                                                                                                  $                                                                 -
  1C  Free-product/contaminated groundwater removal                                                                                                                                             $                                                                 -
  2A Drilling & direct push                                                                                                                                                                     $                                                                 -
  2B  Groundwater monitoring (well sampling & groundwater measurement)                                                                                                                          $                                                                 -
  2C  SCR report preparation                                                                                                                                                                    $                                                                 -
  2D  Additional data collection survey, soil samples, etc.                                                                                                                                     $                                                                 -
  3A Pilot tests & pumping/slug tests                                                                                                                                                           $                                                                 -
  3B  Remediation system design                                                                                                                                                                 $                                                                 -
  3C  CAP report preparation                                                                                                                                                                    $                                                                 -
  3D  Remediation system installation/excavation                                                                                                                                                $                                                                 -
  3E  Remediation system startup & implementation report                                                                                                                                        $                                                                 -
  3F  Remediation system operation & maintenance                                                                                                                                                $                                                                 -
  3G Monitoring plan implementation & report preparation                                                                                                                                        $                                                                 -
  3H  Remediation system decommissioning                                                                                                                                                        $                                                                 -
GRAND TOTAL                                                                                                                                                                                     $                                                                 -

				
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Description: Invoice Oil Change document sample