CITY OF FOSTER
REMOVAL OF UST
AT LIFT STATION 29
Contract # CIP 455-705
Leading
the Way
in Safety ,
Service,
and the
Environment
(951) 398-9873
[email protected]
patriotenvironmental.com
Patriot Environmental Services,
a Crystal Clean company, has
been providing the highest quality
services for the best value with the
utmost safety in mind for more than
two decades.
On behalf of Patriot Environmental Services, Inc.,
we are pleased to present our response to your
Request for Proposal # CIP 455-705 for Removal of
UST at Lift Station 29. We affirm our ability to meet
and exceed the requirements outlined in RFP.
Patriot Environmental Services (Patriot) started
providing reliable environmental, industrial, and
emergency services in 1977 and strives to be the
premier provider of comprehensive environmental
services in the western United States. We
accomplish this by strictly focusing on safe work
performance and environmental compliance, as
well as client and employee satisfaction.
This submittal represents our acceptance of the
performance obligations set out in the RFP and
the described scope of work. We warrant that
we and each of our assigned employees hold the
necessary licenses, permits, insurance, safety
program, capabilities and knowledge to accept
and legally handle all aspects of the work.
The signatory below, Shawn Ball, is authorized
to commit Patriot to the obligations contained
our response.
We thank you for this opportunity and your
consideration. Please feel free to contact us should
you have any questions or require additional
information.
Shawn Ball
Sr . Vice President
Founded on
the values of
safety, integrity,
sustainability and
results, Patriot
Environmental
Services offers more
than just another
choice in full-service
environmental
providers.
Patriot Environmental Services, Inc.
City of Foster | Removal of UST at Lift Station 29
3 Capability and
Past Performance
COMPANY PROFILE
Founded in 1977, Patriot Environmental Services is
a California corporation headquartered in Signal Hill,
California. We currently operate 19 facilities across
California and neighboring states, with ongoing efforts focused on national expansion.
Our team is over 500 strong. All field staff are HAZWOPER- trained professionals, committed to delivering safe,
high-quality work across every project..
1. Our services fall into three core categories:
Environmental Services – Including industrial
cleaning, remediation, ORSO (Oil Spill Response),
and field services.
2. Waste Services – Covering hazardous waste
management, wastewater treatment, oilfield sludge
and mud management, and waste transportation.
3. National Response Services – Encompassing
emergency spill response and preparedness,
decontamination, disaster response and recovery,
and consolidated project management.
Patriot Environmental Services is committed to
protecting people, property, and the environment—one
project at a time.
OUR CAPABILITIES
• “A” rated insurnce coverage with nationwide reach,
certified ORSO provider with nationwide project
management expertise
• Specialized Equipment: Ultra-high pressure hydro
blasting units (up to 40,000 PSI), Chemical cleaning
systems, Robotic tank cleaning equipment, Multi-
phase vacuum trucks, Mobile solidification units,
Emergency response vehicles, Hydro-excavation
trucks, CCTV pipeline inspection systems
• Nationwide Reach and Rapid Response: 24/7
availability with strategically located facilities across the country, facilitating rapid deployment and
comprehensive coverage for any environmental
service need
LOCATIONS & FACILITIES
Patriot Environmental Services, Inc. currently operates four treatment, storage, and disposal facilities and
fourteen regional offices and facilities strategically
located across the United States.
PERSONNEL TRAINING
All Patriot personnel are certified and trained in
accordance with OSHA and EPA requirements. Training
documentation available upon request includes:
• HAZWOPER (40/8-hour)
• CPR/First Aid
• Confined Space Entry/Rescue
• Respirator Fit Testing
• Lockout/Tagout (LOTO)
• Hazardous Waste Categorization and Biohazardous
Waste Handling
PRINCIPAL OFFICERS
Brian Recatto, President
Mark DeVita, Treasurer
Shan Ball, Secretary
David L. Rattner, Assistant Secretary
Alex M. Schmidt, Assistant Secretary
AUTHORIZED SIGNATORY
Shawn Ball, Sr. Vice President
Arizona
California
Colorado
Florida
Nevada
North Carolina
Oregon
Utah
Virginia
Washington
Patriot Environmental Services, Inc.
City of Foster | Removal of UST at Lift Station 29
4 PAST PERFORMANCE
Patriot Environmental Services is a fully licensed and certified hazardous waste management firm with over forty-one years of experience in handling diverse waste streams fully compliant with local, state, and federal regulations, including DTSC, CalEPA, and US EPA requirements. We are uniquely qualified to perform the full scope of services required for the Bldg 10 Hazardous Waste Oily Water Removal at Base Los Angeles Long Beach.
Patriot has been providing the highest quality hazardous and non-hazardous waste services for the best value with the utmost safety in mind for more than two decades. We maintain all required permits and licenses for hazardous waste transportation and disposal. Our team holds current certifications including CPR/First Aid, Confined Space Entry, LOTO, and Respirator Fit Testing.
Patriot performs hazardous waste management and oily water removal services every day as part of our core operations. These services are integral to our expertise, and we are fully equipped to handle them in compliance with all regulatory and environmental standards. To demonstrate our experience and capability, we have included below a sample of projects that reflect the scope, complexity, and quality of work we routinely deliver in this field.
Central Petroleum - Kwik Service UST E-85
Central Petroleum - San Qentin Two 5k Kerosene tanks
PTI Marine - Two 5k Diesel tanks
HazMat1 - 1,000 Gallon AST Diesel Fuel System Removal
Forgen LLC - 10,000 UST Gasoline, 1 - 10,000 Gallon UST Diesel Fuel System Removal Roux Inc. - 1,000 Gallon UST Diesel Fuel System Removal These are just a few examples of clients we currently serve with similar scope, scale, and regulatory requirements as those outlined in the Foster City RFP for the Removal of UST at Lift Station 29. These projects demonstrate our ability to manage complex underground tank removal operations in compliance with federal, state, and local environmental standards.
Patriot Environmental Services, Inc.
City of Foster | Removal of UST at Lift Station 29
5 KNOWLEDGE OF REGULATIONS
The successful management of a project such as Foster City’s requires a combination of experience, regulatory knowledge, strict compliance, and operational flexibility. At Patriot, we bring all of these elements together to ensure consistent, high-quality service delivery.
Our team maintains a thorough and up-to-date understanding of city, state, and federal hazardous waste regulations.
We don’t just hold the required licenses and permits—we actively track regulatory changes and industry best practices to ensure Sacramento County remains in full compliance.
Patriot is recognized as one of the most respected HAZMAT companies in the industry because we prioritize infrastructure, training, and compliance. These are not just checkboxes—they are integral to our success and core to our company culture. We believe every task matters. That’s why every action we take is thoughtful, measured, and aligned with the highest standards of safety and accountability.
With 19 strategically located branches, our personnel bring extensive hands-on experience in both emergency and non-emergency response, site remediation, and the handling and disposal of hazardous, non-hazardous, and biological materials. This depth of experience directly supports our ability to meet the specific needs of Sacramento County and all HAZMAT contracts we manage.
PERSONNEL TRAINING
Patriot provides an initial 40-hour HAZWOPER training class to all personnel prior to assignment to any field projects involving hazardous materials. The course is designed to meet OSHA 29 CFR 1910.120 and U.S. EPA Orders 1440.2 and 1440.3. Patriot’s training regimen includes annual HAZWOPER refreshers that includes medical surveillance, respirator fit test, first aid/CPR, blood-borne pathogens, confined space entry/operations, confined space rescue, and other specialty courses as required. Some employees receive advanced specialized training, such as project or position-specific related inclusive of OSHA hazardous waste supervisor, OSHA competent person (equipment operator, trench/excavation, fall protection, etc.), incident command, OSRO, chlorine response, street chemistry (fentanyl/methamphetamine response), HazCat® unknown identification, tank truck rollover, rail/tank car specialist, MSHA, etc.
Training is conducted and tracked internally by our EHS professionals.
All Patriot personnel are certified and trained in accordance with OSHA and EPA requirements.
Patriot Environmental Services, Inc.
City of Foster | Removal of UST at Lift Station 29
6 Certificate of Completion
This Certifies that
Jamey R Dobbs
has completed the training course for
HAZWOPER Refresher
and is awarded this certificate by
Patriot Environmental Services
under the instruction of Brandon Abbott
on Jan 15th, 2025 , valid until Jan 15th, 2026
Bid Form
City of Foster City 00 4115 - 1
DOCUMENT 00 4115
BID FORM
TO THE CITY OF FOSTER CITY
THIS BID IS SUBMITTED BY:
____________________________________________________________________________________ (Firm/Company Name)
Re:Emergency Generator Replacement (Removal of Underground Storage Tank) at 909 E Hillsdale Boulevard, CIP 455-705
1. The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an agreement with the CITY OF FOSTER CITY in the form included in the Contract Documents, Document 00 5205 (Construction Services Agreement), to perform and furnish all Work as specified or indicated in the Contract Documents for the Contract Sum and within the Contract Time indicated in this Bid and in accordance with all other terms and conditions of the Contract Documents.
2. Bidder accepts all of the terms and conditions of the Contract Documents, Document 00 1115 (Notice Inviting Bids), and Document 00 2115 (Instructions to Bidders) including, without limitation, those dealing with the disposition of Bid Security. This Bid will remain subject to acceptance for 60 Days after the day of Bid opening, unless there is a bid protest, then 90 days after the day of bid opening.
3. In submitting this Bid, Bidder represents that Bidder has examined all of the Contract Documents, performed all necessary Pre-Bid investigations, attended the mandatory Pre-Bid Meeting, received the Pre-Bid Meeting minutes (if any), and received the following Addenda:
Addendum Number ADDENDUM DATE Signature of Bidder
4. Based on the foregoing, Bidder proposes and agrees to fully perform the Work within the time stated and in strict accordance with the Contract Documents for the following sums of money listed in the following Schedule of Bid Prices:
(Continued on next page)
Patriot Environmental Services, Inc.
11/03/251
Bid Form
City of Foster City 00 4115 - 2
SCHEDULE OF BID PRICES
All Bid items, including lump sums, unit prices and alternates (if any), must be filled in completely. Bid items are described in Contract Documents. Quote in figures only, unless words are specifically requested.
ITEM
DESCRIPTION
ESTIMATED
QUANTITY
UNIT UNIT PRICE
TOTAL
1. Mobilization (5% max of
the total bid price)
1 LS
$
$
2. Stormwater Pollution
Prevention & Control
Plan
1 LS
$
$
3. Permitting 1 LS
$
$
4. Site Preparation 1 LS
$
$
5. Concrete Cutting and
Demolition
1 LS
$
$
6. Tank Cleaning and
Inerting
1 LS
$
$
7. Fuel System
Disconnection and
Removal
1 LS
$
$
8. UST and Day Tank
Removal and Backfill
1 LS
$
$
9. Surface Restoration 1 LS
$
$
10. Waste Handling and
Disposal
1 LS
$
$
11. Reporting and Closure
Documentation
1 LS
$
$
TOTAL
TOTAL BID
PRICE
$
Total Bid Price:
______________________________________________________________________ (Indicate Bid Price in Words)
5. The undersigned acknowledges that the Apparent Low Bidder will be determined as provided in Documents 00 1115 (Notice to Bidders) and Document 00 2115 (Instruction to Bidders).
6. Subcontractors for work are listed on Document 00 4330 (Subcontractors List), submitted herewith.
7. The undersigned Bidder understands that Owner reserves the right to reject this Bid. 3,000.003,000.00
162,227 .00
16,900.0016,900.00
16,816.0016,816.00
26,773.0026,773.00
37 ,069.0037 ,069.00
27 ,802.0027 ,802.00
9,267 .009,267 .00
9,053.009,053.00
4,600.004,600.00
4,689.004,689.00
6258.006258.00
One hundred-sixty-two thousand, two hundred twenty-seven dollars
Bid Form
City of Foster City 00 4115 - 3
8. If written notice of the acceptance of this Bid, hereinafter referred to as Notice of Award, is mailed or delivered to the undersigned Bidder within the time described in Paragraph 2 of this Document 00 4115 or at any other time thereafter before it is wit hdrawn, the undersigned Bidder will execute and deliver the documents required by Document 00 2115 (Instructions to Bidders) within the times specified therein.
9. Notice of Award or request for additional information may be addressed to the undersigned Bidder at the address set forth below.
10. The undersigned Bidder herewith encloses cash, a cashier’s check, or certified check of or on a responsible bank in the United States, or a corporate surety bond furnished by a surety authorized to do a surety business in the State of California, in form s pecified in Document 00 2115 (Instructions to Bidders), in the amount of ten percent of the Total Bid Price and made payable to the CITY OF FOSTER CITY/ESTERO MUNICIPAL IMPROVEMENT DISTRICT.
11. The undersigned Bidder agrees to commence Work on the date established in, and to complete all Work within the time specified in, Document 00 5205 (Construction Services Agreement).
12. The undersigned Bidder agrees that liquidated damages for failure to complete all Work in the Contract within the time specified in Document 00 5205 (Construction Services Agreement) shall be as set forth in Document 00 5205.
13. The names of all persons interested in the foregoing Bid as principals are:
[_________________________________]
IMPORTANT NOTICE:
If Bidder or other interested person is a corporation, give the legal name of corporation, state where incorporated, and names of president and secretary thereof. If a partnership, give name of the firm and names of all individual co-partners composing the firm. If Bidder or other interested person is an individual, give first and last names in full.
NAME OF BIDDER: ___________________________________________________________________
licensed in accordance with an act for the registration of Contractors, and with license number:
_____________________________________ Expiration: __________________.
____________________________________________________________________________________ (Place of Incorporation, if Applicable) (Principal)
_____________________________________________
(Principal)
_____________________________________________
(Principal)
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
___________________________________________
(Signature of Bidder)
NOTE: If Bidder is a corporation, set forth the legal name of the corporation together with the signature of the officer or officers authorized to sign contracts on behalf of the corporation. If Bidder is a Shawn Ball, Sr. Vice President
Patriot Environmental Services, Inc.
8099990 06/30/26
California Shawn Ball, Sr. Vice President
Bid Form
City of Foster City 00 4115 - 4
partnership, set forth the name of the firm together with the signature of the partner or partners authorized to sign contracts on behalf of the partnership.
Business Address: __________________________________________
__________________________________________
__________________________________________
Contractor’s Representative(s): __________________________________________ (Name/Title)
__________________________________________
(Name/Title)
__________________________________________
(Name/Title)
Officers Authorized to Sign Contracts __________________________________________ (Name/Title)
__________________________________________
(Name/Title)
__________________________________________
(Name/Title)
Telephone Number(s): __________________________________________ (Area Code) (Number)
__________________________________________
(Area Code) (Number)
Fax Number(s): __________________________________________ (Area Code) (Number)
__________________________________________
(Area Code) (Number)
Date of Bid: __________________________________________
END OF DOCUMENT
1250 23rd St
Signal Hill, CA 90755
Shawn Ball, Sr. Vice President
(951) 840-9686
(562) 436-2688
11/20/25
Ambrose Kong, Operations Manager
Bidder Registration Form
City of Foster City 00-4325 - 1
DOCUMENT 00 4325
BIDDER REGISTRATION FORM
INDEPENDENT CONTRACTOR REGISTRATION
Contractor’s License #
Date: Fed I.D. #
Full Corporate Name of Company:
Street Address:
Mailing Address:
Phone: Fax:
Name of Principal Contact:
Type of Business: _____ Sole Proprietor _____ Partnership _____ Non-Profit 501(c)(3) _____ Corporation
_____ other (please explain:__________________________________)
INSURANCE
Workers’ Compensation:
Carrier:
Address:
Phone and Fax:
Policy Number:
General Liability:
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
8099990
11/20/25 95-3894635
Patriot Environmental Services, Inc.
1250 23rd St
Signal Hill, CA 90755
P.O. Box 1091
Long Beach, CA 90801-1091
(951) 840-9686 (562) 436-2688
Heide Rainey
X
AIU Insurance Company
14570350 (AOS), 14570351 (WI)
Ironshore Specialty Insurance Company
IEPUW0030496101
$5M/ea occ; $5M Gen Agg
A
1271 Avenue of the Americans, 35th Floor, New York, NY
877-399-6442
175 Berkeley St, Boston, MA
617-357-9500
Bidder Registration Form
City of Foster City 00-4325 - 2
Automobile Liability:
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
All-risk Course of Construction
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
All-Risk Course of Construction:
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
Professional Liability (if applicable):
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
National Union Fire Ins Co Pittsburgh PA
14570352
$5M
Beazley Excess and Surplus Insurance, Inc
D375C8250201
Limit $10M; SIR $100,000
A
N/A
N/A
1271 Avenue of the Americans, 35th Floor, New York, NY
212-770-7000
The Rutherford Building, 65 Memorial Rd, Ste 3, West Harford, CT 860-677-3700
860-677-3700
Bidder Registration Form
City of Foster City 00-4325 - 3
A.M. Best Rating:
Pollution Legal Liability Insurance (if applicable):
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
Excess Liability Insurance (if applicable):
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
Other Liability Insurance (if applicable):
Carrier:
Address:
Phone and Fax:
Policy Number:
Policy Limits: $
A.M. Best Rating:
EXPERIENCE OF PRIME CONTRACTOR
The nature of this Project requires prior similar experience for the firm and the Key Personnel assigned.
Summarize similar project experience below and provide the detailed project information requested:
Prime Contractor. List three projects of similar size and scope to the Work of the Contract, completed in the past five (5) years, and indicate who were the superintendent, project manager, and scheduler.
NOTE: This listing will be used to assess compliance with the stated minimum qualifications in Paragraph
1.01. Beazley Excess and Surplus Insurance, Inc
Nautilus Insurance Company
D375C8250201
FFX2034932-14
Markel
Limit $10M; SIR $100,000
Limit $10M; SIR $500,000
$5M each occ; $5M Agg
MKLV3ENV105283
Site Pollution Liability
A
A
A
A+
The Rutherford Building, 65 Memorial Rd, Ste 3, West Harford, CT 860-677-3700
7233 East Butherus Drive, Scottsdale, AZ
480-509-6627
4521 Highwoods Parkway , Glen Allen, VA
800-431-3888
Bidder Registration Form
City of Foster City 00-4325 - 4
Project Name Construction
Cost ($)
Year
Completed
Name of
Project
Superintendent
Name of
Project
Manager
Name of
Project
Scheduler
Key Personnel.
List Key Personnel that will be assigned to the Work of the current Project and their experience/training with the projects listed above:
Project Manager: _____________________________________________________________________
Project Superintendent: ________________________________________________________________
Project Scheduler: ____________________________________________________________________
Recent Projects.
Provide information about three (3) of its most currently completed projects. Names and references must be current and verifiable. This listing will be used to assess compliance with the stated minimum qualifications in Paragraphs 1.01. If a separate sheet is used, it must contain all of the following information:
1. Project Name: __________________________________________________________________
Location: _________________________________________________________________________
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
1,000 Gallon
AST Diesel
Fuel System
Removal
665 3rd
Street San
Francisco,
Ca. Lumens
Kwik Serve UST E-85
10,000 UST
Gasoline, 1 -
10,000 Gallon
UST Diesel
Fuel System
Removal 20150
County Road
124, West
Sacramento,
CA
1,000 Gallon
UST Diesel
Fuel System
Removal
201 Cypress
Avenue
$16,214.75
$30,702.00
$63,225.00
2023
2022
2022
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Jamey Dobbs
Bidder Registration Form
City of Foster City 00-4325 - 5
Owner: __________________________________________________________________________
Owner Contact (name and phone): ____________________________________________________
Architect/Engineer: _________________________________________________________________
Architect/Engineer Contact (name and phone number): ____________________________________
Const. Mgr. or Project Mgr. (name and phone number): ____________________________________
Description of Project, Scope of Work Performed: _________________________________________
________________________________________________________________________________
Total Construction Cost: _____________________________________________________________
Total Change Order Amount: _________________________________________________________
Did Change Orders exceed 10% of original contract sum? ___________ If yes, please explain on separate sheet.
Original Scheduled Date of Completion: ________________________________________________
Time Extensions Granted (number of Days): _____________________________________________
Actual Date of Completion: ___________________________________________________________
Number of Stop Notices filed by Subcontractors or Suppliers: _______________________________
2. Project Name: _____________________________________________________________________
Location: _________________________________________________________________________
Owner: __________________________________________________________________________
Owner Contact (name and phone): ____________________________________________________
Architect/Engineer: _________________________________________________________________
Architect/Engineer Contact (name and phone number): ____________________________________
Const. Mgr. Or Project Mgr. (name and phone number):____________________________________
Description of Project, Scope of Work Performed: ________________________________________
________________________________________________________________________________
Total Construction Cost: ____________________________________________________________
Total Change Order Amount: ________________________________________________________
Did Change Orders exceed 10% of original contract sum? ___________ If yes, please explain on separate sheet.
Original Scheduled Date of Completion: ________________________________________________
Central Petroleum
Mike Springs/Chris Dabbit
N/A
N/A
N/A
No
No
September 2025 (on time on schedule)
None
None
September 2025
N/A
N/A
N/A
Kwik Serve UST E-85
$17 ,015.48
$20,575.80
On time, On schedule, No change orders
On time, On schedule, No change orders
San Quentin Two 5k Kerosene tanks
San Quentin Two 5k Kerosene tanks
January 2025
Central Petroleum
Mike Springs/ Chris Dabbit
Bidder Registration Form
City of Foster City 00-4325 - 6
Time Extensions Granted (number of Days): _____________________________________________
Actual Date of Completion: ___________________________________________________________
Number of Stop Notices filed by Subcontractors or Suppliers: _______________________________
3. Project Name: _____________________________________________________________________
Location: _________________________________________________________________________
Owner: __________________________________________________________________________
Owner Contact (name and phone): ____________________________________________________
Architect/Engineer: _________________________________________________________________
Architect/Engineer Contact (name and phone number): ____________________________________
Const. Mgr. Or Project Mgr. (name and phone number): ____________________________________
Description of Project, Scope of Work Performed: _________________________________________
________________________________________________________________________________
Total Construction Cost: _____________________________________________________________
Total Change Order Amount:_________________________________________________________
Did Change Orders exceed 10% of original contract sum? ___________ If yes, please explain on separate sheet.
Original Scheduled Date of Completion: ________________________________________________
Time Extensions Granted (number of Days): _____________________________________________
Actual Date of Completion: ___________________________________________________________
Number of Stop Notices filed by Subcontractors or Suppliers: _______________________________
BIDDER CERTIFIES, UNDER PENALTY OF PERJURY, THAT THE FOREGOING INFORMATION IS
CURRENT AND ACCURATE AND AUTHORIZES OWNER, AND ITS AGENTS AND
REPRESENTATIVES TO OBTAIN A CREDIT REPORT AND/OR VERIFY ANY OF THE ABOVE INFORMATION.
BIDDER: ______________________________________________________________________ (COMPANY NAME)
By: ____________________________
NAME TITLE
By: ____________________________
SIGNATURE DATE
Patriot Environmental Services, Inc.
Shawn Ball Sr. Vice President
11/20/25
N/A
Jesse Brockman
January 2025
May 2025
May 2025
PTI Marine two 15k Diesel tanks San Francisco
PTI Marine two 15k Diesel tanks San Francisco
$14,714.22
N/A
None
None
None
No
PTL Marine
Jesse Ramos
Mike Hernandez
On time, On schedule, No change orders
Bidder Registration Form
City of Foster City 00-4325 - 7
SAFETY EXPERIENCE
The following statements as to the Bidder’s safety experience are submitted with the Bid, as part thereof, and the Bidder guarantees the truthfulness and accuracy of all information.
1. List Bidder’s interstate Experience Modification Rate for the last three years.
[202__] _____ [202__] _____ [202__] _____
2. Use Bidder’s last year's Cal/OSHA 300/301 log to fill in the following number of injuries and illnesses:
a. Number of lost workday cases _______________
b. Number of medical treatment cases _______________
c. Number of fatalities _______________
3. Employee hours worked last year _______________
4. State the name of Bidder’s safety engineer/manager:
Attach a resume or outline of this individual's safety and health qualifications and experience.
I CERTIFY, UNDER PENALTY OF PERJURY, THAT THE FOREGOING INFORMATION IS CURRENT
AND ACCURATE AND I AUTHORIZE OWNER, AND ITS AGENTS AND REPRE SENTATIVES TO OBTAIN A CREDIT REPORT AND/OR VERIFY ANY OF THE ABOVE INFORMATION.
BIDDER:
By: ________________________________________________
Signature
Its: _________________________________________________ Title
Date_________________________________________________
END OF DOCUMENT
Shawn Ball
5 1.53 4 31.05 1.09
0 3
0 896,828
Andy Puget, Director, Health and Safety
11/20/25
VINCENT (ANDY) PUGET
DIRECTOR HEALTH AND SAFETY
EDUCATION
California State
University-Bakersfield
BA Psychology
California State
University-Bakersfield
MS Counseling
TRAINING AND
CERTIFICATIONS
40-hr. HAZWOPER and
annual 8-hr. Refreshers
30-hr. OSHA
TWIC
e-RailSafe
HAZMAT (DOT &
NONDOT)
First Aid/CPR
MAJOR PROJECTS
Thomas Fire (SCE) - 2018
Crimson Pipeline Spill – 2016
Refugio Oil Spill – 2015
BP Deep Horizon - 2009
QUALIFICATIONS
Andy Puget is a results -oriented and dedicated health and saf ety professional with more than 11 years of safety experience. His experience and expertise includes all aspects of Confined Space and Rescue; reviewing, developing and writing policie s, programs, safe operating procedures, and best practices to minimize HSE risks and ensure health and safety of employe es; incident reporting , investigations, and root cause analysis; performed injury management/case management with designated medical providers; managed drug testing protocol s; leading safety meetings; performing JHAs, JSA audits and reviews; project planning (including HSPs, JHAs, SDPs, Project Compliance Plans, etc.), and established a robust safety culture through the constant promotion of safety as a core value and effectively decreased TRIR from a company average of 1.60 to 0.45 to 0.23 in one year.
He manages all daily aspects of the multi-regional EHS Department in reviewing, developin g, and writing policies, programs, safe operating procedures, training programs, and best practices to minimize E HS risks and ensure the health and safety of employees while ensuring all elements meet or exceed both customer and regulatory (federal, state, and local [including OSHA and EPA]) requirements and regulations. Develops, implements and manages the drug testing protocol. Represents the company in dealings with Federal, State and local agencies for enforcing safety and health law regulations.
EXPERIENCE
Patriot Environmental
Services
2021 - Present
Director Health and Safety
2016-2018
Director of HSE
2015-2016
Regional HSE Manager
Rincon Consultants, Inc.
2021
EHS Manager
Trinity Safety Company
2019 - 2020
Operations / Safety Manager
Accuworx West Env. Services
2018-2019
Director of EHS
Chevon Env. Management Co.
201-2015
HES Consultant
Subcontractors List
City of Foster City 00-4330 - 1
DOCUMENT 00 4330
SUBCONTRACTORS LIST
The Subcontractors List must include the names of all subcontractors for those subcontractors who will perform any portion of Work, including labor, rendering of service, or specially fabricating and installing a portion of the Work or improvement accordin g to detailed drawings contained in the plans and specifications, in excess of one half of one percent (0.5%) of the total Bid amount. (Public Contract Code § 4104.)
Name of Subcontractor and
Location of Place of Business
Description of
Work
Subcontractor’s
License No.
DIR Registration
Number*
(Bidder to attach additional sheets if necessary)
* Pursuant to Division 2, Part 7, Chapter 1 (commencing with section 1720) of the California Labor Code.
END OF DOCUMENT
Sierra Asphalt
Traffic Management
Nahams Trucking
West Coast Marine
Chemist
Central Valley
Engineering and Asphalt
Asphalt/Concrete
Placement
Traffic Control/
Parking and
Pedestrian
Control
Trucking | waste
soil hauling (if
needed)
Marine Chemist N/A N/A - Professional
work (inspection
and certification
only)
Asphalt/Concrete
Placement
457414
785804
773404
N/A
1000001305
11000005229
10000049040
10000012491
Non-Collusion Affidavit (CS)
City of Foster City 00-4519 - 1
DOCUMENT 00 4519
NON-COLLUSION AFFIDAVIT
PUBLIC CONTRACT CODE SECTION 7106
NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID
The undersigned declares:
I am the ______________________ of _________________, the party making the foregoing bid.
The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.
Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on _____________[date], at _____________[city], _______________[state].
BIDDER’S SIGNATURE:
NAME/TITLE OF SIGNATORY:
LEGAL NAME OF BIDDER:
END OF DOCUMENT
Sr. Vice President
Patriot
Environmental
Services, Inc.
11/20/25 Signal Hill California
Shawn Ball, Sr. Vice President
Patriot Environmental Services, Inc.
Rev. 0
February 2022
Bidder Certifications
City of Foster City 00-4545 - 1
DOCUMENT 00 4545
BIDDER CERTIFICATIONS
TO BE EXECUTED BY ALL BIDDERS AND SUBMITTED WITH BID
The undersigned Bidder certifies to Owner as set forth in sections 1 through 9 below.
1. STATEMENT OF CONVICTIONS
By my signature hereunder, I hereby swear, under penalty of perjury, that no more than one final, unappealable finding of contempt of court by a Federal Court has been issued against Bidder within the past two years because of failure to comply with an ord er of a Federal Court or to comply with an order of the National Labor Relations Board.
2. CERTIFICATION OF WORKER’S COMPENSATION INSURANCE
By my signature hereunder, as the Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code that require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this Contract.
3. CERTIFICATION OF PREVAILING WAGE RATES AND RECORDS
By my signature hereunder, as the Contractor, I certify that I am aware of the provisions of Labor Code Section 1773, which requires the payment of prevailing wage on public projects. I further certify that Contractor and any subcontractors under the Cont ractor shall comply with Labor Code Section 1776, regarding wage records, and with Labor Code Section 1777.5, regarding the employment and training of apprentices. It is the Contractor’s responsibility to ensure compliance by any and all subcontractors performing work under this Contract.
4. CERTIFICATION OF SKILLED AND TRAINED WORKFORCE PROGRAM By my signature here, Pursuant to Public Contract Code section 2602 and if and to the extent otherwise required by law, as the contractor, I certify that contractors and subcontractors at every tier will comply with the Skilled and Trained Workforce Requir ements of Public Contract Code Chapter 2.9 (Sections 2600 through 2603). Contractor also understands and acknowledges that it shall provide the Owner a monthly report, in the form appended to Document 00 4645 or a substantially similar form, demonstrating compliance with the Skilled and Trained Workforce Requirements listed in Public Contract Code Chapter 2.9 (Sections 2600 through 2603). If Contractor fails to provide the monthly report, or a report that is incomplete, Owner will withhold future payments until a complete report is provided. The definitions, obligations, rights and remedies set forth in Public Contract Code Section 2600-2603 are hereby incorporated by reference and made a part of this agreement.
5. CERTIFICATION OF COMPLIANCE WITH PUBLIC WORKS CHAPTER OF LABOR CODE By my signature hereunder, as the Contractor, I certify that I am aware of Sections 1777.1 and 1777.7 of the California Labor Code, Contractor, and Subcontractors, and am eligible to bid and work on public works projects.
6. CERTIFICATION OF NON-DISCRIMINATION
By my signature hereunder, as the Contractor, I certify that there will be no discrimination in employment with regard to race, color, religion, gender, sexual orientation, age or national origin; that all federal, state, and local directives and executive orders regarding non-discrimination in employment will be complied with; and that the principal of equal opportunity in employment will be demonstrated positively and aggressively.
Rev. 0
February 2022
Bidder Certifications
City of Foster City 00-4545 - 2
7. CERTIFICATION OF NON-DISQUALIFICATION
By my signature hereunder, as the Contractor, I swear, under penalty of perjury, that the below indicated Bidder, any officer of Bidder, or any employee of Bidder who has a proprietary interest in such Bidder, has never been disqualified, removed, or other wise prevented from bidding on, or completing a Federal, State, or local government project because of a violation of law or safety regulation, except as indicated on the separate sheet attached hereto entitled “Previous Disqualifications.” If a statement of “Previous Disqualifications” is attached, please explain the circumstances.
8. CERTIFICATION OF ADEQUACY OF CONTRACT AMOUNT
By my signature hereunder, as the Contractor, pursuant to Labor Code Section 2810(a), I certify that, if awarded the Contract based on the undersigned’s Bid, the Contract will include funds sufficient to allow the Contractor to comply with all applicable local, state, and federal laws or regulations governing the labor or services to be provided. I understand that Owner will be relying on this certification if it awards the Contract to the undersigned.
9. CERTIFICATION REGARDING DIR CONTRACTOR / SUBCONTRACTOR REGISTRATION By my signature hereunder, as the Contractor, I certify that Contractor, and all Subcontractors listed on Document 00 4330 (Subcontractors List) are the subject of current and active contractor registrations pursuant to Division 2, Part 7, Chapter 1 (commencing with section 1720) of the California Labor Code.
Contractor’s registration number is [please complete] _____________________ . Subcontractors’ registration numbers are as indicated in Document 00 4330.
BIDDER:
(Name of Bidder)
Date: ___________________, [20 ] By:
(Signature)
Name:
(Print Name)
Its:
(Title)
END OF DOCUMENT
10000392
November 20 25
Patriot Environmental Services, Inc.
Shawn Ball
Sr. Vice President
See Page Two to Complete This Form Approved 7/8/03
COMPLIANCE & ENFORCEMENT DIVISION
Notification Form
Regulation 8
Rule 40
REMOVAL OF UNDERGROUND STORAGE TANKS OR TREATMENT OF CONTAMINATED SOIL
SITE OF ACTIVITY
Site Address: City & Zip: Site#:
Specific Location of Project within Address:
Owner/Operator:
Check any that apply (400 numbers refer to regulation section requiring reporting):
Tank Removal or Replacement (401) Contaminated Soil Excavation and Removal (402) Aeration of Soil < 50 ppmw organic content, but does not meet Section 118 Exemption (403) Section 114 Exempt; Date Pipeline Leak Started: Vol. Of Soil: (403) Section 115 Exempt; Date Contamination Unrelated to UST Activities Discovered: (405) If only Tank Removal is selected, attach results showing soil is not contaminated
CONTRACTOR INFORMATION
Name: Site Contact: Phone:
Address:
TANK REMOVAL (Section 401)
Scheduled Start Date: Number and Size of Tank(s):
Explain Methods of:
Piping drainage or flushing (310.1)
Liquid and sludge removal (310.2)
Vapor removal (310.3) [Check One] Water Displacement Vapor Freeing* Ventilation* * Emission controls required for vapor freeing or ventilation if tank size greater than 250 gallons.
COMPLETE INFORMATION BELOW OR ATTACH SAMPLE RESULTS SHOWING SOIL IS UNCONTAMINATED (310.4) CONTAMINATED SOIL EXCAVATION AND REMOVAL (Section 402) Scheduled Start Date: Scheduled Completion Date:
Purpose of Excavation:
Quantity of Soil: Organic Content & Type:
Methods used to quantify and analyze soil:
Method of Stockpile Control (304-306)
Water Spray Covered Vapor Suppressant (List Material Used):
Method of Site Closure (306)
Backfilled Contaminated Soil Removed
Onsite Treatment (Describe): A/C or P/O #:
Loaded Trucks Covered? (306.2) Yes No
AERATION OF SOIL < 50 PPMW ORGANIC CONTENT (Section 403) You must submit a Permit Application and Risk Screening Analysis (Forms will be sent to you)
FOR BAAQMD USE ONLY
Fax/PM Date: By: Disp to I#: Area: Date: By:
Inv Req Date: By: Fwd to Supv. Date: By:
Press to clear form
OTHER PUBLIC AGENCY CONTACTED (Fire District, Hazardous Materials, City or County)? Agency Name: Contact Name:
Address: Phone:
EMERGENCY REMOVAL ORDER APPLICABLE?
Agency Name: Contact Name:
Address: Phone:
H:\Pub_data\Janet\Reg 8-40\forms\notifdraft3.doc
GENERAL INFORMATION
• This notification form shall be used to notify the BAAQMD of any projects subject to the reporting requirements in Regulation 8, Rule 40, Sections 401 through 405. Notifications may be emailed to [email protected]; or mailed to the address listed at the bottom of this form. • An invoice for payment will be sent to the person listed under "Contractor Information" as the person responsible, unless the project is exempt from fee payment (see next item). • See "Frequently Asked Questions" (FAQ) for definition of projects, change procedures, permit requirements, emergency conditions, project exemptions, and fee exemptions. For any questions not answered in the FAQ, contact the Compliance Assistance Counselor at (415) 749-4999.
INSTRUCTIONS
• SITE OF ACTIVITY: Give the site street address and indicate if it has any existing BAAQMD site number, for either a plant or GDF. Identify the specific project location if the site contains more than one building.
Indicate all applicable activity types by checking appropriate boxes. For reporting requirements under Sections 401 through 403, additional information is required, as below. • CONTRACTOR INFORMATION: Identify the contractor that is responsible for performing the work at the site location listed. This contractor is also responsible for payment of the applicable notification fee, if the project is not exempt.
• SECTION 401 - TANK REMOVAL/REPLACEMENT: All soils disturbed and/or excavated as part of the tank removal shall be subject to the requirements of Sections 304 through 306, unless the soil has been determined not to be contaminated by measurement of organic content using the procedures in Sections 601 and 602. Complete requirements for Section 402 or submit sample results showing that the soil is not contaminated.
• SECTION 402 - CONTAMINATED SOIL EXCAVATION AND REMOVAL:
• Be as accurate as possible for the Scheduled Start and Completion Dates. Specific requirements apply for excavation projects triggered within either 45 or 90 days (Reg. 8-40-306.4) and Authority to Construct requirements for projects lasting longer than three months (Reg. 2-1-128.16). • If a vapor suppressant is used, attach a product data sheet or MSDS. • If Method of Site Closure used is Onsite Treatment, describe specific method, (e.g., bioremediation, vapor extraction, air sparging, thermal desorption, etc.).
• If Onsite Treatment is used, indicate whether an Authority to Construct was obtained by providing the Application No. or attach copy of BAAQMD Certification of Exemption. • SECTION 403 – AERATION OF SOIL < 50 PPMW ORGANIC CONTENT: Section 301 exempts from control the aeration of soil containing less than 50 ppmw of organic compounds, but Section 403 still requires reporting of ANY soil aeration. If such a project does not meet the exemption criteria of Section 118, then a Permit Application and Risk Screening Analysis must be submitted. • EMERGENCY REMOVAL INFORMATION (IF APPLICABLE): The rule defines an emergency tank removal or excavation of contaminated soil as "carried out pursuant to an order of a state or local government agency issued because the contaminated soil poses an imminent threat to public health and safety." If the project(s) meet this definition, then identify the agency that issued the order. Under Section 402 requirements, on line two, identify the purpose as indicated in the order. 375 Beale Street, Suite 600, San Francisco, CA 94105
www.baaqmd.gov
All Various Locations Plans expire one (1) year from the date of issuance. To apply for a new Plan, submit an application with the filing fee at least one month prior to the Plan expiration date. For an application package and fee information please go to the SCAQMD web page at http://www.agmd.gov/comply/formsbyrule.htmand look for Rule I infi rmation F r tion call 232 ."
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4178
..,._...._. (909) 396-2000 • www.aqmd.gov
PLAN ISSUE DATE
COMPANYI.D.:
Mitigation Plan/Application No.
Applicant:
Attention:
Phone
August 12, 2025
138248
577193
Patriot Environmental Services
P. 0. Box I 091
Long Beach, CA 9080 l
Marc Ruffner, Director ofOSRO Services
(562) 436-2614 Email: [email protected]
Reference is made to your application ( A/N 567274) for the excavation and handling ofVOC -contaminated soil at various locations within the South Coast Air Quality Management District.
In accordance with Rule 1166 (c), this approved plan is required prior to commencing excavation ofany areas, sites, or locations which has previously been used to store or transfer volatile organic compounds (VOC) or during the excavation, handling, or storage oNOC-contaminated soils.
The rights and privileges granted through the issuance of this plan are restricted exclusively to the plan holder to whom it was issued, and are non -transferable, even with the written or expressed consent of the plan holder listed above.
AVARIOUS LOCATIONS PLAN can be used at a site to excavate and remove a maximum of2000 cubic yards of VOC contaminated soil at the site. Any treatment or additional excavation ofVOC contaminated soil at the site will require the issuance of a SITE SPECIFIC plan by the AQMD. Multiple uses ofVARIOUS LOCATIONS PLANS to excavate over 2000 cubic yards ofcontaminated soil for the same site is prohibited per Rule I 166.
This excavation and mitigation plan has been approved under the provisions of Rule 1166 of the Rules and Regulations of the AQMD and is subject to the following conditions.
THIS PLAN WILL EXPIRE ONE YEAR FROM THE ISSUE DATE AND
'l'HERE IS NO AU'l'OMA'l'IC RENEWAL PROCESS.
Page I
Plan#: 577193
VARIOUS L OCATIONS
RULE 1166 CONTAMINATED SOIL MITIGATION PLAN
voe
YARDS, voe
voe
voe
CONTAMINATED SOIL, IS CONSIDERED AS voe CONTAMINATED SOIL FROM THE TIME
PLAN CONDITIONS
SECTION1- GENERAL REQUIREMEN1S
l. A SIGNED COPY OF THIS PLAN SHALL BE PRESENT AT EACH EXCAVATION SITE AT ALL TIMES AND SHALL BE MADE AVAll.ABLE TO AQMD PERSONNEL UPON REQUEST.
2. THIS PLAN IS NOT VALID FOR THE EXCAVATION OF voe CONTAMINATED SOILS AT LANDFILLS OR SITES USED FOR DISPOSAL OF REFUSE OR OTHER TYPES OF WASTE.
3. THIS PLAN DOES NOT ALLOW THE TREATMENT OF voe -CONTAMINATED SOIL BY THERMAL, CHEMICAL, OR MECHANICAL PROCESSES. ANY OF THE ABOVE TREATMENT PROCESSES REQUIRES A PERMIT TO OPERATE FROM THE AQMD AND A SITE-SPECIFIC RULE 1166 PLAN.
4. THIS PLAN DOES NOT ALLOW BACK-FILLING OF TREATED voe CONTAMINATED SOIL. BACK- FILLING OF TREATED voe CONTAMINATED SOIL MAY BE ALLOWED UNDER A SITE-SPECIFIC RULE 1166 PLAN.
5. THE TOTAL QUANTITY OF VOCCONTAMINATED SOIL EXCAVATED AND HANDLED AT EACH SITE SHALL NOT EXCEED 2,000 CUBIC THIS TOTAL INCLUDES ANY
CONTAMINATED SOILS EXCAVATED FROM THIS LOCATION UNDER A VARIOUS LOCATION PLAN WITHIN THE LAST TWELVE (12) CALENDAR MONTHS. EXCAVATIONS INVOLVING QUANTITIES IN EXCESS OF 2000 CUBIC YARDS OF CONTAMINATED SOIL REQUIRES THE APPLICATION SUBMITTAL FOR A SITE-SPECIFIC RULE 1166 EXCAVATION PLAN.
6. THE AQMD SHALL BE IMMEDIATELY NOTIFIED OF ANY COMPLAINTS RECEIVED AS A RESULT OF ACTMTIES CONDUCTED UNDER THIS PLAN. SUCH NOTIFICATION SHALL INCLUDE THE NATURE
OF THE COMPLAINT, NUMBER OF COMPLAINANTS AND THE ACTION TAKEN BY THE PLAN HOLDER TO MITIGATE THE SOURCE OF THE COMPLAINT.
7. DURING EACH STEP OF THE PROCESS UP TO AND INCLUDING THE REMOVAL AND DISPOSAL
PROCESS, ALL PRECAUTIONS AND MEASURES SHALL BE TAKEN TO MINIMIZE THE RELEASE OF voe, ODOR AND DUST. THIS INCLUDES, BUT IS NOT LIMITED TO:
A) THE USE OF ADDITIONAL PLASTIC SHEETING OR SUPPRESSANTS ON EXPOSED SOIL
SURFACES AND WORK AREAS,
B) MAINTAINING PAVED PUBLIC STREETS FREE OF SOIL DEPOSITS, AND C) OPERATING SUCH THT SOIL SHALL NOT BE SPREAD ON-SITE OR OFF-SITE; AND NOT
PERFORMING ANY UNNECESSARY MOVEMENT OR AGITATION OF SOIL, INCLUDING THE
RESHAPING OR RELOCATION OF STOCKPILES, THAT MAY CAUSE THE UNCONTROLLED
EVAPORATION OF INTO THE ATMOSPHERE
8. F
v
O
o
R
e
TH E PURPOSES OF RULE 1166 AND THIS PLAN, SOIL MEASURED PURSUANT TO RULE 1166 AS
OF MEASUREMENT ONWARD, UNTIL THE SOIL IS TREATED PURSUANT TO AN APPROVED AQMD TREATMENT PROCESS.
Plan#: 577193
SECTION II-PRIOR TO EXCAVATION
9. AT LEAST 24 HOURS PRIOR TO COMMENCING EXCAVATION OR GRADING OF SOIL AT THE SITE,
THE EXECUTIVE OFFICER OR DESIGNEE SHALL BE NOTIFIED OF THE EXCAVATION BY FAX
USING A FORM APPROVED BY THE EXECUTIVE OFFICER, WHICH IS FULLY COMPLETED AND
INCLUDING, THE NAME OF THE COMPANY PERFORMING THE EXCAVATION, AND THE APPLICATION NUMBER LISTED ON THIS MITIGATION PLAN. THE NOTIFICATION SHALL BE MADE BY FAXING THE NOTIFICATION FORM AT (909) 396 -3342. FAX NOTIFICATIONS WILL RECEIVE A
REFERENCE NUMBER BY RETURN FAX OR CAN BE OBTAINED REFERENCING THE FAX NOTIFICATION BY PHONE TUESDAY THROUGH FRIDAY DURING BUSINESS HOURS AT 909 396- 2326. THE REFERENCE NUMBER SHALL BE RETAINED AS PROOF OF COMPLIANCE WITH THIS REQUIREMENT.
REFERENCE NO: NOTIFICATION DATE:.
10. COMPLETE VERIFICATION INFORMATION IN CONDITION NO. 29 AND OBTAIN REQUIRED SIGNATURES, PRIOR TO COMMENCING EXCAVATION.
SECTION Ill - MONITORIN G
II. DURING THE EXCAVATION PROCESS, AN ORGANIC VAPOR ANALYZER (OVA) SHALL BE ON SITE AT ALL TIMES. THE OVA SHALL BE MAINTAINED IN GOOD WORKING ORDER AT ALL
TIMES AND SHALL BE CALIBRATED BY THE MANUFACTURER AT LEAST ONCE EVERY THREE MONTHS. THE CALIBRATION OF THE OVA SHALL BE VERIFIED USING CERTIFIED
CALIBRATION GAS AT THE BEGINNING OF EACH WORKING DAY WITH THE PROCEDURES SPECIFIED BY THE MANUFACTURER. IF A CALIBRATION GAS OTHER THAN HEXANE IS USED,
EACH MEASURED READING SHALL BE CORRELATED TO AND EXPRESSED AS HEXANE, USING EQUIVALENCY FACTORS PROVIDED BY THE MANUFACTURER.
12. ALL MONITORING SHALL BE CONDUCTED AT A DISTANCE NO MORE THAN 3 INCHES ABOVE THE SOIL SURFACE USING AN OVA DESCRIBED IN CONDITION NO. l l ABOVE. MONITORING
SHALL BE CONDUCTED AT A MINIMUM FREQUENCY OF ONE READING FOR EVERY TWO
CUBIC YARDS OF SOIL EXCAVATED, NOT TO EXCEED FIFTEEN MINUTES BETWEEN READINGS. ALL READINGS SHALL BE TAKEN NO LATER THAN THREE (3) MINUTES AFTER EACH LOAD OF SOIL IS EXCAVATED.
13. ALL MONITORING SHALL BE CONDUCTED BY TRAINED PERSONNEL WHO ARE PROFICIENT IN THE USE OF THE HYDROCARBON MONITOR SELECTED FOR USE AT THIS SITE.
14. WRITTEN RECORDS OF OVA MONITORING AND CALIBRATIONS REQUIRED ABOVE SHALL BE KEPT IN A FORMAT APPROVED BY THE AQMD. THE APPROVED FORMAT IS INCLUDED ON PAGE 8 OF THIS PLAN. THE CERTIFICATION ON ALL RECORDS SHALL BE SIGNED AND DATED ON THE DAY THE MEASUREMENTS ARE OBSERVED.
15. UPON DETECTION OF voe CONTAMINATED SOIL (READINGS 50 PPM OR GREATER), THE EXECUTIVE OFFICER OR DESIGNEE SHALL BE NOTIFIED WITIDN 24 HOURS OF THE FIRST DETECTION OF voe CONTAMINATION. THE NOTIFICATION SHALL BE MADE BY FAXING THE NOTIFICATION FORM TO (909) 396 -3342 OR CALLING (909) 396- 2326. A REFERENCE NUMBER WILL BE FAXED BACK OR WILL BE ISSUED WHEN THE PHONE NOTIFICATION IS RECEIVED.
ALL PHONE NOTIFICATIONS SHALL BE FOLLOWED BY MAILING THE NOTIFICATION FORM TO THE DISTRICT POSTMARKED WITHIN 48 HOURS. THE REFERENCE NUMBER WILL BE RETAINED AS PROOF OF COMPLIANCE WITH THIS REQUIREMENT.
REFERENCE NO: NOTIFICATION DATE:
SECTION JV-HANDLING AND STORAGE
l6. ALL VOC -CONTAMINATED SOIL BELOW 1000 PPM SHALL BE STOCKPILED, COVERED WITH
PLASTIC SHEETING AND STORED SEPARATELY FROM NON- VOC-CONTAMINATED SOIL, OR IMMEDIATELY TRANSPORTED TO A TREATMENT FACILITY.
Page3
Plan#: 577193
17. A STOCKPILE SHALL NOT CONTAIN MORE THAN 400 CUBIC YARDS OF SOIL.
18. IF THE OVA MEASUREMENT IS GREATER THAN 50 PPMV BUT LESS THAN !000 PPMV
A) THE AFFECTED WORK AREA AND LOAD OF SOIL SHALL BE SPRAYED WITH WATER AND/OR APPROVED VAPOR SUPPRESSANT.
B) CONTAMINATED SOIL IN STOCKPILES SHALL BE COVERED WITH PLASTIC SHEETING
WHICH OVERLAP A MINIMUM OF TWENTY-FOUR INCHES AND ARE SECURED SO THAT NO PORTION OF THE CONTAMINATED SOIL IS EXPOSED TO THE ATMOSPHERE. IN THE
COURSE OF HANDLING THE STOCKPILE, ONLY THE WORKING FACE OF THE STOCKPILE MAY BE UNCOVERED.
19. IF THE SOIL OVA MEASUREMENT EQUALS OR IS GREATER THAN 1000 PPMV, NOTIFY THE
DISTRICT IMMEDIATELY OR WITHIN ONE HOUR OF DETECTION, AND,
A) THE AFFECTED SOIL AND WORKING AREA SHALL BE IMMEDIATELY SPRAYED WITH WATER OR AN APPROVED VAPOR SUPPRESSANT, AND EITHER:
i) THE CONTAMINATED SOIL EXCAVATED SHALL BE IMMEDIATELY
PLACED IN AQMD APPROVED SEALED CONTAINERS
EQUIPPED WITH VAPOR TIGHT LIDS, OR,
ii) THE SOIL SHALL BE DIRECTLY LOADED IN TRUCKS, SPRAYED WITH ADDITIONAL
WATER OR APPROVED VAPOR SUPPRESSANTS, COVERED, AND TRANSPORTED
IMMEDIATELY OFF SITE TO AN APPROVED TREATMENT FACILITY, OR,
B) HANDLED BY ALTERNATIVE STORAGE METHODS WITH PRIOR WRITTEN APPROVAL FROM THE AQMD.
20. DURING EXCAVATION, THE ONLY EXPOSED voe CONTAMINATED SOIL SHALL BE RESTRICTED TO THE IMMEDIATE WORKING AREA OF THE SITE OR STOCKPILE. ALL OTHER PORTIONS OF
THE STOCKPILE SHALL BE COVERED WITH PLASTIC SHEETING, WITH SEAMS, WHICH OVERLAP A MINIMUM OF TWENTY-FOUR INCHES AND ARE SECURED WITH DUCT TAPE. ANY EXPOSED voe-CONTAMINATED SOIL SURFACES (WORK FACE) SHALL BE KEPT MOIST WITH WATER OR
OTHER APPROVED SUPPRESSANTS AT ALL TIMES AND SHALL BE RE-COVERED DURING PERIODS OF INACTIVITY LONGER THAN ONE (I) HOUR. AT THE END OF EACH WORKING DAY,
ALL STOCKPILES SHALL BE COMPLETELY COVERED AND SECURELY ANCHORED TO PREVENT ANY EXPOSURE OF SOIL TO THE ATMOSPHERE.
21. ONCE COVERED WITH PLASTIC SHEETING, STOCKPILES SHALL REMAIN UNDISTURBED UNTIL REMOVED FROM SITE.
22. DAILY INSPECTIONS SHALL BE CONDUCTED OF ALL COVERED VOC- CONTAMINATED STOCKPILES TO ENSURE THE INTEGRITY OF THE PLASTIC COVER. SUCH INSPECTIONS SHALL INCLUDE A VISUAL INSPECTION OF ALL SEAMS AND PLASTIC COVER SUR.FACES.
ANY HOLES, TEARS OR ANY OTHER POTENTIAL SOURCES OF FUGITIVE VOC EMISSIONS SHALL BE REPAIRED IMMEDIATELY. DAILY RECORDS SHALL BE MAINTAINED TO ENSURE COMPLIANCE WITH THIS CONDITION.
SECTION V-SOJL REMOVAL AND DISPOSAL
23. ALL EXCAVATED VOC -CONTAMINATED SOIL SHALL BE REMOVED FROM THE SITE WITHIN THIRTY (30) DAYS OF ITS EXCAVATION.
24. ALL VOC-CONTAMINATED SOIL REMOVED FROM THE SITE SHALL COMPLY WITH THE FOLLOWING:
A) BE TRANSPORTED TO AN APPROVED TREATMENT/DISPOSAL FACILITY. IT SHALL BE
THE RESPONSIBILITY OF THE PLAN HOLDER TO ENSURE THAT THE RECEIVING
TREATMENT/DISPOSAL FACILITY HAS RECEIVED APPROVAL FROM THE APPROPRIATE
Page4 Plan#:
577193
ENVIRONMENTAL OVERSIGHT AGENCIES TO HANDLE AND TREAT voe CONTAMINATED SOILS.
B) WHEN LOADING IS COMPLETED AND DURING TRANSPORTATION, NO EXCAVATED MATERIAL SHALL EXTEND ABOVE THE SIDES OR REAR OF THE TRUCK OR TRAILER.
C) PRIOR TO COVERING/TARPING,
D) .
A) SECTION VJ - RECORDS AND REPORTINGLOADED CONTAMINATED SOIL SHALL BE TREATED BY SPRAYING WITH WATER OR DUST SUPPRESSANTS.
B) THE TRUCK OR TRAILER SHALL BE COMPLETELY COVERED/TARPED PRIOR TO
LEAYING THE SITE TO PREVENT PARTICULATE EMISSIONS TO THE ATMOSPHERE.
THE EXTERIOR OF THE TRUCKS (INCLUDING THE TIRES) SHALL BE CLEANED OFF PRIOR TO THE
TRUCKS LEAYING THE EXCAVATION SITE
25. A WRITTEN REPORT SHALL BE PROVIDED TO THE AQMD WITHIN 30 DAYS OF INITIAL DETECTION OF CONTAMINATED SOIL, WHICH INCLUDES THE FOLLOWING INFORMATION.
A) THE STATUS OF THE EXCAVATION PIT, AND ANY voe
CONTAMINATED SOIL REMAINING ON SITE.
B) A BRIEF SUMMARY INDICATING IF ADDITIONAL CLEAN UP EFFORTS ARE NECESSARY, THE ADDITIONAL QUANTITY OF voe CONTAMINATED SOILS TO BE EXCAVATED AND THE PROJECTED SCHEDULE OF THE EXCAVATION.
26. RECORDS OF DISPOSAL SHALL BE MAINTAINED FOR ALL VOC -CONTAMINATED SOIL REMOVED FROM THIS SITE. SUCH RECORDS SHALL BE CLEARLY LABELED "SCAQMD RULE 1166-VOC CONTAMINATED SOIL" AND SHALL INCLUDE THE IDENTIFICATION AND THE LOCATION OF, 1) THE GENERATOR, 2) TRANSPORTER AND 3) RECEIVING FACILITY. IN
ADDITION, SUCH RECORDS SHALL BE SIGNED AND DATED BY EACH OF THE ABOVE
PARTIES INDICATING RECEIPT OR RELINQUISHMENT OF THE VOC-CONTAMINATED SOIL AT THE TIME CUSTODY IS TRANSFERRED.
27. RECORDS OF DISPOSAL OF voe -CONTAMINATED SOIL SHALL BE MAINTAINED ON SITE DURING THE EXCAVATION AND LATER MAINTAINED FOR A PERIOD OF TWO (2) YEARS. THE RECORDS SHALL BE MADE AVAILABLE TO AQMD PERSONNEL UPON REQUEST.
28. WITHIN THIRTY (30) DAYS AFTER THE EXCAVATION AT THE SITE IS COMPLETED, THE WRITTEN RECORDS UNDER CONDITIONS NO. 14, 22, AND 27 SHALL BE SUBMITTED TO THE AQMD AT THE FOLLOWING ADDRESS.
SOUTH COAST AIR QUALITY MGMT DISTRICT
ENGINEERING & COMPLIANCE DIVISION
TOXICS & WASTE MANAGEMENT UNIT
(RULE 1166 COMPLIANCE)
21865 E. COPLEY DR.
DIAMOND BAR, CA. 91765-4182
Page5 Plan#:
577193
SECTION VII� VERIFICATION AND SIGNATURE
29. THIS PLAN IS NOT VALID UNTIL ALL PARTIES HAVE REVIEWED AND SIGNED THE VERIFICATION STATEMENT BELOW.
7ritel 'fame I Type of Business
An<119SS TT-tty I 'P
Responsible Party (Owner/Operator) I Phone
ti I
11ore59 City Zip
I CERTIFY THAT I HAVE REVIEWED AND UNDERSTAND THE CONDITIONS CONTAINED WITHIN THIS PLAN. IN SIGNING BELOW, I ACKNOWLEDGE THAT UNDER THE PROVISIONS OF RULE I 166, I CAN BE HELD RESPONSIBLE FOR THE REQUIREMENTS SET FORTH IN THIS PLAN.
ResponsibJe Party KespDnsible Parly: Signature date :slgnea General Contractor Genel':111 Contractor Signature date :sl8ned E1c1vation Contractor Exca"vat1on Contractor: 1;nature D.11te Signed Environmental Consultant En'rironmental Consultant 51gaature Date Signed
DEFINITIONS
Excavation
Organic Vapor Analyzer (OVA)
Responsible Party
VOC Contaminated Soil
Volatile Organic Compound (VOC)
Is the process of digging out and removing materials including any material necessary to that process such as the digging out and removal of asphalt or concrete necessary to expose, dig out and remove known VOC contaminated soil.
For the purposes of this plan, an OVA is an hydrocarbon monitor utilizing flame ionization, photo ionization or other analytical methods complying with 40 CFR PART 60 APPENDIX A, EPA METHOD 21 SECTION 3, "DETERMINATION OF VOLATILE ORGANIC COMPOUND LEAKS,
MONITORING INSTRUMENT SPECIFICATIONS. The monitor shall be capable of being calibrated using hexane at a range of O parts per million by volume (PPMV) to 50 PPMV, and at a detection range of at least 30 PPMV to I100 PPMV
For the purposes of this plan, Responsible Party is the party financially responsible for initiating the excavation. This may include the property owner or the tank operator. This excludes contractors working for the property owner or operator, and any other party that lacks the direct authority to immediately treat all voe contaminated soils generated at the excavation site.
Is soil that registers a concentration of 50 PPM or greater of volatile organic compounds as measured before suppression materials have been applied and at a distance ofno more than three inches from the surface of the excavated soil with an organic vapor analyzer calibrated with hexane.
Is any volatile compound of carbon, excluding methane, carbon monoxide, carbon dioxide, carbonic acid, metallic carbides or carbonates, ammonium carbonate, and exempt compounds. Exempt compounds areas defined in Rule 102 - Definitions of Ter111s�
Once issued, this plan is subject to further review by the AQMD and max be revoked if excavation activities are found in violation of plan condit10ns or AQMD's Rules and Regulations. Failure to comply with one or more or the conditions contained within this plan constitutes a violation of Rules 22 l and 1166.
Other governmental agencies may require approval before any excavation begins. It shall be the responsibility of the applicant to obtain that approval. The South Coast Air Quality Management District shall not be responsible or liable for any losses because of measures required or taken pursuant to the requirements ofthis approved Rule 1166 Contaminated Soil Mitigation Plan.
Questions regarding this plan should be directed to Lizabeth Gomez, (909) 396-3103. �1�
Company Name
Patriot Environmental Services
P. 0. Box 1091
Long Beach, CA 90801
Facility/Site Information
Reference No(s).
Plan#: 577193
1.0.#: 138248
Monitor lnformation
Brand:
Calibration Data
Gas:
Name:
Monitoring Personnel Excavation Summary
(Upon completion ofeach page)
Total Cubic Yds
'This page\
Model: Date Company: Total Cubic Yds
Todatel
Type By Phone: Removed from
Site To date
Time
Every
15min.
voe Concentration IPPMVJ@
Excavated Load
Comment Tim
e
Ever
voe Concentration (PPMVJ@ Comment
Excavated Load
I certify that the1nfonnat1on contained 1n the above document 1s true and correct I further certify that the above listed hydrocarbon monitor was operated in a manner consistent with the manufacturers specifications and the conditions specified within this plan. In addition, I certify that the above readings represent the actual measurements I observed and recorded during the excavation process.
SIGNATURE.: _ DATE.:
Hexane
Factor
Reading Adjusted
Reading
Hexane
Factor
Readin
g
South Coast Air Quality Management District
21865 Copley Drive, Diamond Bar, CA91765
1-800-CUT-SMOG www.aqmd.gov
July 1, 2025
IMPORTANT NOTICE 2025
Rules 203, 1149 and 1166 Fees
TO COMPANIES AND CONTRACTORS THAT:
Operate portable soil/vapor extraction units at a location for 5 days or more (Rule203J Degas storage tanks known/suspected to contajn Volatile Organic Compounds (VOC) (Rule 1149) Remove tanks or transfer piping known/ suspected to contain voe (Rule 1166) Handle, excavate, grade, monitor or treat soil known/suspected to conta;n VOC (Rule 1166)
South Coast AQMD Regulation Ill - Fee amendments for the Fiscal Years 2025-26 increased notification fees across-the- board. All required notifications for soil vapor extraction projects, tank degassing projects, and excavation of VOC soil projects, are subject to the new fee per Rule 301(x) effective July 1st, 2025. See fee schedule below:
Fiscal Year Notification Fee
2025..2026 $81.61
The fee is per notification and an additional service charge fee of $25.00 may apply for any returned check per Rule 313(h).
Initial notifications must be emailed to [email protected] and the original notification and fee must be postmarked within 48 hours of the fax time.
South Coast AQMD recommends mailing your notification to save time, money, reduce traffic, conserve energy use and avoid air pollution. For your convenience please mail all notjfications and fees to the following mailing address:
South Coast AQMD
P.O. Box 55641
Los Angeles, CA 90074-5641
Notifications should be completed, signed, mailed and the fee paid by the contractor performing the project.
Notifications submitted without a fee are deemed incomplete and they will be returned to sender and referred to the Air Toxics Compliance Unit.
Rules 203, 1149 and 1166 notification forms, instructions, and information can be obtained from the South Coast AQMD web site at www.agmd.gov
The forms are located at our home page, click on Business / Forms / Forms Arranged By Rule or the Rule link below.
203 Soil Vapor Extraction (SVE) Notification Form
1166 voe Emissions from Soil Excavation Notification Form 1149 Storage Tank Degassing Notification Form
For any Rule 203/1149/1166 questions call the above Rules Hot Line at (909) 396-2326.
NOTE: Rule 304{e) requires an owner/operator to pay for analysis of South Coast AQMO field samples showing non compliance.
I
(check one only) Extra
□
ction (SVE) Conta
□
minated Soil of voe Soil/Tank ppm v
□
oe Soil ppm voe
□
soil
(check one only) !
PROJECT DATES START END WORK SHIFT day swing night
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
SVE Operation (R203) or Rule 1166 NOTIFICATION FORM
Use this form to notify of operation of a Soil Vapor Extraction unit (SVE); or prior to Excavating, Handling, Monitoring, Treating known or suspect Volatile Organic Compounds (VOC) contaminated soil per R1166. See instructions on the back of this form. For questions check our website at www.agmd.gov or call the Hotline at (909) 396-2326.
FAX this form to 909·396·3342 and within 48 hours of the fax, MAIL the original form and fee to:
SCAQMD • 1166/203 Notifications, File# 55641, Los Angeles, CA 90074•5641 This form will be faxed back to you with a REFERENCE number if you provide a FAXBACK # here:
AQMD USE ONLY RECEIVED BY POSTMARK REFERENCE#
COMPLETED BY Company Patroit Environmental Srvs Phone# (562) 436-2614 Date Check# Amount Project#
NOTIFICATION TYPE Origiio/ritial) Revision (p r
□
io r reference#) Cancellation lrior reference#)
PROJECT TYPE 1 Soil Vapor 2 R1166 Treating 2 R1166 Excavation 2 R1166 Reporting > 50 2 R1166 Reporting > 1000 0 1 SVE Permit issued to (name): 1 SVE Permit Number:
1 SVE Distance to nearest sensitive receptor in feet (see your permit condition requirements):
2 R1166 Mitigation Plan issued to (name): 2R1166 Plan Number:
2 R1166 - Date & time of voe > 50 or 1000 ppm exceedance: Highest VO C □
re adin g in pp
□
m:
□
SITE CONTRACTOR INFORMATION AQMD ID# 138248 CSLB License# Phone# Name Patriot Environmental Srvs Address
City Zip Site supv name & phone#
SITE INFORMATION Site Name Site AQMD ID#
Site Address Cross Street
Site City Zip Site contact name & phone#
TANK INFORMATION II OF TANKS EACH CAPACITY (gal) MATERIAL STORED IN TANK ABOVE GROUND? (Y/N) @
@
Example 3 tanks @ 10,000 Gasoline no
INFORMATION CERTIFICATION I certify that the above information is complete and accurate Company Name Print Name Signature Date
COMMENTS
Revised 08/04/2010 Page 1 of 2
;Reset.
Rule 203 and Rule 1166 Form Notification Instructions
Use this form to notify of operation of a Soil Vapor Extraction unit (SVE) at any site for more than 5 days per permit condition (R203); or for notifying about R1166 projects prior to excavating soil that is known or suspected to contain Volatile Organic Compounds (VOC), VOC tank excavation, discovering the presence of> 50 ppm and 1000 ppm VOC contaminated soil during soil excavation, or to notify of onsite VOC contaminated soil mitigation or treating.
For questions check our website at www.aqmd.gov or call the Hotline at (909) 396-2326 NOTIFICATION FEES: Per Rule 301(x) any person required to submit a notification per Rule 1166 projects or Rule 203 -Soil Vapor Extraction projects must pay a notification fee per notification. The current notification fee is $81.61.
FAX all notifications to (909) 396-3342 and then MAIL the form and fee within 48 hours of fax to:
SCAQMD Rule 1166 / 203 Notifications, File# 55641, Los Angeles, CA 90074-5641 Notifications must include the following MANDATORY information:
Faxback # - Provide your fax# at the top of the Notification Form if you want a Reference# faxed back to you.
Notification Type - CIRCLE the type of Notification. Original is for new or initial Notifications. Revisions are for updating information on notifications in which the project End Date has not expired. Provide the most recent prior Reference# issued for Revisions or Cancellations.
Project Type - CIRCLE the type of work you are submitting a notification for. A separate notification and fee is required for each type of work selected.
Mitigation Plan/Permit - Each Project Type requires a valid R1166 Mitigation Plan or SVE Permit# (important).
Site Contractor Information - Provide the information for the actual contractor doing the work. The AQMD ID#, also known as Company or Facility ID#, can be found on the contractor's AQMD Mitigation Plan, Permits or invoices.
Site Information - Provide the site name and complete address. Include the street number and name, city, zip code, and nearest cross street. Give more detailed directions for site(s) difficult to locate.
Project Dates - Provide the project Start and End Dates. Any changes will require a Revision notification.
Tank Information - For R1166 tank excavation specify the tank capacity, the VOC material stored in the tank, and if the tank is above ground (a/g) or underground (u/g).
Information Certification - The notification must be signed and dated by the contractor doing the work or authorized representative to confirm that the information provided is complete and accurate.
SOIL/TANK EXCAVATION NOTIFICATION Rule 1166(c )(1 )(B) Notify 24 hours prior of intent to Excavate known or suspected voe storage and/or transfer equipment (includes diesel and waste oil tanks); or handling known or suspected VOC contaminated soil. NOTE: Soil excavation> 5,000 cubic yards may require a R403 Fugitive Dust Plan.
DETECTING/FINDING voe SOIL NOTIFICATION - Rule 1166(c )(1)(D)(ii) • within 1 hour of detecting voe greater than 1000 ppm* • within 24 hours of detecting voe greater than 50 ppm
Notify of finding voe contaminated soil
EMERGENCY NOTIFICATION Rule 1166(c )(1)(B) Notify prior to start work of any incident declared an emergency by an authorized agency requiring immediate tank removal/repairs or excavating/handling known or suspected VOC soil:
• Call 1·800-CUT·SMOG prior to excavating or fax the emergency notification to 909-396-3342 and • Mail the notification within 48 hours after the excavation including the agency Order or Declaration.
SOIL VAPOR EXTRACTION NOTIFICATION (SVE - Rule 203 *) Notify upon the 5th day after operating at a new site:
Notifying of start-up or testing of operation of portable Soil Vapor Extraction equipment lasting 5 days or more.
Provide the distance in feet to the nearest sensitive receptor if the site is located less than ¼ mile from any Long-Term Health Care Facility, Rehabilitation Center, Convalescent Center, Retirement Home, Residence, School, Playground, Child Care Center or Athletic Facility (* See your SVE permit condition requirements).
MITIGATION/TREATING VOC SOIL NOTIFICATION (Rule 203 *) Notify per Permit condition requirements when:
Notifying of on-site mitigation or treating of VOC contaminated soil (* See your Permit condition requirements).
Revised 08/04/2010 Page 2 of 2
upon the recommendation of the Board of Certified Safety Professionals, by virtue of the authority vested in it, has conferred on the credential of
and has granted the title as evidence of meeting the qualifications and passing the required examination so long as this credential is not suspended or revoked and is renewed annually and meets all recertification requirements.
Board President
Board Secretary
Date Issued
Credential Number
The digital badge is the official documentation of the certificate.
Vincent W Pempeit III
Associate Safety Professional
October 3, 2014
ASP-A15426
September 8, 2022
To Whom It May Concern:
This letter attests that Vincent William Pempeit III is an NFPA Certificated Marine Chemist, Qualification Certificate Number: 719 and has met the qualifications established by the National Fire Protection Association to discharge the duties of a Marine Chemist.† The expiration date of this certification is is: October 1, 2027 unless sooner cancelled.
This statement verifying the credentials of the above named individual as a NFPA Certificated Marine Chemist is to be used during the ongoing COVID-19 outbreak that has interrupted normal business operations of the NFPA. As soon as normal business operations are reestablished, Qualification Certificate documentation that has been signed by the President of the Association will be presented to the above named individual. Questions about the certification status of the aboved named NFPA Certificated Marine Chemist should be directed to the Executive Secretary of the Marine Chemist Qualification Board. A directory of current Marine Chemists is available on the Certificated Marine Chemist page on the NFPA website:
https://www.nfpa.org/Training-and-Events/Certification/Certification/Marine-chemists
For the Marine Chemist Qualification Board
Lawrence B. Russell
Executive Secretary | MCQB
Tel: 617-984-7499 | Email: [email protected]
General Limitations: The Qualification Certificate referred to above was issued on terms and conditions stated therein and on the basis of the Rules for the Certification of Marine Chemists (a copy of which Rules and of the form of said Certificate should be examined and may be obtained from the NFPA on request) and upon information believed to be reliable. But no other representation and no warranty or guarantee, express or implied, is made in connection therewith. The Qualification Certificate may be suspended or cancelled by the NFPA at anytime without notice. † Includes the Special Endorsement for Flammable Cryogenic Liquids (FCL).
The International Code Council (ICC) recognizes and uses National Fire Protection Association (NFPA) standards,
though it doesn’t directly certify NFPA credentials. The ICC has a collaborative relationship with the NFPA.
Jeffery Hanson
CIH-CP 10589
May 29, 2014
Dec 01, 2029