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Petroleum Tank Release Cleanup Fund ` Standardized Proposal and Invoice Form Limited fife Inve~tigafion (LSI) or dull ~iemedial Inve~tigagion <:~~3'.;~,'~~' ~ons4afldard scope og UV®rrk MPCA Leak tlF 17991 Applican4 Name City of Ullle Canada Site Name L:illle Canada PuUlic Works Shop_ _ _ Addl'8SS G1 G I ittle Canada Roatl Site Addfess 3100 Country (hive _ Lillie Canada, MN 65717 Lillie Canada, MN 5511'/ 'T'ask Uoscriptlon Amount Proposod Amount Invoicod for Proposod Tasks Adm6tlatratlvo'fasks~ Agency status update 5105 per field work event _ S Applicant status update [drillinq~ $.57?. per drilling event SII0.00 S _ Applicant status update [quarterly sanytling) 5154 per quarterly sampling event $ $ t3ackground review 5616 per leak site S Drum disposal manaycment S30b per disposal 5 5 Field work notification and scheduling 5209 per field work event/see rule 5160.00 S Health and sate( flan _ Y t 5275 per leak rile S Nonspecific administration 5770 per step of services _ _ 560 00 $ _ Off-site access time $1,100 per required off-site property 5 Sample shipping and Transportation $99 per shipping event 575.00 $ State duty officer emergency contact 5105 per call $ S Consultan4l7rllllny and F.xcavatlon Actlvitlos _ Urillitty oversiyht, field lag prep, & soil sampling [2~ or shallower boring] 5165 per boring $760.00 S Drilliny oversiyht, field log prep, & soil sampliny (boring deeper than 2.v ~ 57 per fool 5195.00 S Free product recovery through hand bailing or portable pump 5116 per well per event S S Hydraulic conductivity field test 5154 per nee. tested well $ 5 Moni(oriny well installation oversighl & development [up to 2 hrs.] $30II per well 5 5 ~ _ _ Monitoring well installation oversight & development (beyond 2 hrs] $462 per wall S S Monitoring well sealing oversight $7"7 per well $ Surve inc &curve in, e<ui orient 5209 ter curve inr event ~ 565.00 Y J Y 9 { 1 I Y 1 ~ _ Surveying & surveying equipmont picensed pro surveyor necessary] 5II75 per surveyin-g event $ _ _ 5 Temporary vrell installation oversighl [7v or shallmver well] 5165 per well S S Temporary well installation oversight [w811 deeper than 2v ] 57 per foot S Utility Uackfill investigation 577 per hand auger bonny $ _ _ S Utility clearance 5720 per utikly clearance event S 5 _ Utility clearance (private utility locator necessary] g550 pet clearance event S_ 100 00 S ~ _ Plold and Rscop¢or Surveys _ Karst field survey $7,17II 5 5 Surface water receptor survey and risk evaluation $154 per leak site 50.00 5 _ _ Vapor receptor survey and risk evaluation 5'770 per leak site plus: 565.00 5 _ • citizen contact (beyond II] • $19 each of of add9 contacts: • subsurface monitoring point [Ueyond II] • $39 each i1_of add I pis Water well receptor survey and risk evaluation 5625 per leak site plus: 565.00_ S • citizen contactor property surveyed (Ueyond 15J • 539 each a or a0d'I_cc or ps: m Sampling AST soil sampling 539 per sample on chaimof-custody 5 S Composted soil sampling 577 per sampling avert $ _ $ Contaminated stockpile soil sampliny S39 per sample on chain-of-custody S S _ _ Excavation soil sampling [tank being removed or abandoned] S77/tank * $3.b5/cy excavated S 5 _ _ L=xcavation soil sampling (tank not being removed or abandoned] 51.54 per cubic yard excavated 5 S [xcavation soil sampling test pit excavation) S77 per test pit 5 5 _ Groundwater sampling (permanent monitorin-g welq 5135lwcll per sampling event 5_ 5 Groundwater sampling (other than permanent monitoring well) S39 per sampling point 565.00 S I-and-treated soil cam tlin 577 ter cam lint event $ S • See Minn. Rides, Chapter 2aad for conydefe inlormalion.'fhese values am summarized oral are Doty a guide. Page 1 of 3 7/2006