HomeMy WebLinkAbout20251068.tiffResolution
Approve Application for Supplemental Reimbursement for Petroleum Storage Tank
Remediation at Fueling Facility (1113 H Street, Greeley) Performed by Palmetto
Environmental Group, LLC, and Authorize Chair to Sign
Whereas, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
Whereas, the Board has been presented with an Application for Supplemental
Reimbursement for Petroleum Storage Tank Remediation at the Fueling Facility
(1113 H Street, Greeley) from the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Departments of
Accounting, Fleet Services, and Facilities, and Palmetto Environmental Group, LLC, to
the Colorado Department of Labor and Employment, Division of Oil and Public Safety,
commencing upon full execution of signatures, with further terms and conditions being as
stated in said application, and
Whereas, after review, the Board deems it advisable to approve said application, a copy
of which is attached hereto and incorporated herein by reference.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that the Application for Supplemental Reimbursement for Petroleum Storage
Tank Remediation at the Fueling Facility (1113 H Street, Greeley) from the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Departments of Accounting, Fleet Services, and Facilities, and
Palmetto Environmental Group, LLC, to the Colorado Department of Labor and
Employment, Division of Oil and Public Safety, be, and hereby is, approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said application.
cc : FT(vs/FA), ACT(cP/RW/cb)
o5 /,) /25
2025-1068
BG0027
FT0004
AC0023
Application for Supplemental Reimbursement for Petroleum Storage Tank Remediation
at Fueling Facility (1113 H Street, Greeley) Performed by Palmetto Environmental Group,
LLC
Page 2
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 21st day of April, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppler: Aye
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
2025-1068
BG0027
FT0004
AC0023
q 351
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Colorado Petroleum Tank Storage Fund Reimbursement
DEPARTMENT: Accounting/Fleet Services
PERSON REQUESTING: Rusty Williams/David Springer
DATE: April 7, 2025
Brief description of the problem/issue:
During constructipn work on the Greeley fuel site in 2021, there was contamination found under the site. The
Palmetto Environmental Group (Palmetto) was hired to clean ap the contamination. The State requires that the
contamination be monitored for seven years after it was found. The cost of the environmental services for this
work are eligible for reimbursement from the Colorado Petroleum Storage Tank Fund.
The work completed by Palmetto from 11/6/24 to 3/27/25 to*aled $11,484.79. Palmetto is now asking for the
board's signature on a Colorado Petroleum Storage Tank Fund reimbursement request so that the County can
be reimbursed fo- the cost of the cleanup.
The board signed similar requests for Palmetto in 2021, 2022, 2023, and 2024. This should be the final request
for this site because the release event has been closed.
What options exist for the Board?
Signing the request authorizes the State to reimburse the county for the $11,484.79 costs incurred for the
cleanup.
Consequences:
Impacts:
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
Recommendation:
We recommend the board sign the request to receive the reimbursement.
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
Support Recommendation
Place on BOCC Agenda
Via email
`mss//
Vi a emcu p
Schedule
Work Session Other/Comments:
2025-1068
et cozy
FT0004
RCOOZ3
Karla Ford
From:
Sent:
To:
Subject:
Importance:
support.
COU NTY, CO
Scott James
Wednesday April 9, 2025 2:14 PM
Karla Ford
Re: Please Reply - Pass -Around for Colorado Petroleum Tank Storage Fund
Reimbursement
High
Scott K. James
Weld County Commissioner
Office: 970 400-4200/Cell : 970-381-7496
P.O. Box 758, 1150 O St., Greeley, CO 80632
0 CD
On Apr 9, 2025, at 1:04 PM, Karla Ford <kford@weld.gov>wrote:
Please advise if you support recommendation and to have department place on the agenda.
<image001.png>
Karla Ford
Office Manager & Executive Assistant
Board of Weld County Commissioners
Desk: 970-400-4200/970-400-4228
P.O. Box 758, 1150 O St., Greeley, CO 80632
<image002.png>
<image003.png>
IMPORTANT: This electronic transmission and any attached documents or other writings are intended only for the
person or entity to which it is addressed and may contain informati xi that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by
return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action
1
Karla Ford
From:
Sent:
To:
Subject:
Lynette Peppier
Thursday, April 10, 2025 8:04 AN1
Karla Ford
Re: Please Reply - Pass -Around for Colorado Petroleum Tank Storage Fund
Reimbursement
I'm okwith this going to agenda
Lynette Peppler
Weld County Commissioner, District 3
1150 0 Street, P.O. Box 758, Greeley, Colorado 80632
970.400-4205 (Office)
970-305-7243 (Cell)
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed
and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender oy return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of
this communication or ony attachments by anyone other than the named recipient is strictly prohibited.
From: Karla Ford <kford@weld.gov>
Sent: Wednesday, April 9, 2025 3:08:02 PM
To: Lynette Peppier <ipeppler@weld.gov>
Subject: Please Reply - Pass -Around for Colorado Petroleum Tank Storage Fund Reimbursement
Please advise if you support recommendation and to have department place on the agenda.
r:•) !3 h l .
COUNTY, CO
Karla Ford
Office Manager & Executive Assistant
Board of Weld County Commissioners
Desk: 970-400-4200/970-400-4228
P.O. Box 758, 1150 O St., Greeley, CO 80632
OM 0
COLORADO PETROLEUM STORAGE TANK SUPPLEMENTAL REIMBURSEMENT APPLICATION
FUND Snort Form S (2024)
ibis form should be used and can only be used, on Supplemental Reimbursement Applications when the
Applicant has already established eligibility for re/mbursement of remediatlon costs relative to this occurrence.
' " x.
a
The nature of this Supplemental Reimbursement Application is: [Select all that apply'
Additional costs not previously reimbursed. ,I X
Other (Explain):
List PREQ # of last application previously filed for this remediation:
46030
Applicant's Full
Legal Name:
Weld County Government
Social Security # or Federal
Tax ID #
84-6000813
Contact Person:
Rusty Williams
Phone # 970.400.4445
Fax #
Mailing Address:
street 1150 O Street
Email: rwilliamstilweld.gov
City: Greeley StateCO ##
Reimbursement
Mailing Address
(if different) :
Remit Entity:
S re'
City: State Zip
Email
Applicant is (select one$: , Government
Other:
Site Name:
Weld County Fueling Facility
Site Address:
Sty: 1113 H Street
City: Greeley State CO Zip 80632
r , ,'�+� I'8ft/'�s�lr(�Qg�r1r'e�� Gt)rrS tt l , - r x
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Applicant's
Representative
(if applicable)
Name Palmetto Environmental Group
Address 4995 York St.
Email: palmetto.generalCci?nwestco.com
City Denver State CO ZIP 80216
Phone # 303.825.8117
Fast/
Total from Listing of Costs, last column:
$11,484.79
Less reimbursement from any other source (see #5):
NET REIMBURSEMENT REQUEST:
$11,484.79
Dates of work covered by this application 'From: i
11/6/24
to:3/27/25
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Revised 4/18/24
'Prior versions of this application veil not be accepted
Page 1 of 4
REIMBURSEMENT INFORMATION
1
Will there be additional reimbursement applications for this release?
No
2
Have any of the costs submitted for reimbursement already been submitted with another reimbursement
application? If yes, identify these costs and explain why you are resubmitting these costs:
NO
3
Do any of the costs submitted for reimbursement cover a time period for which you have already received, or
requested reimbursement? If yes, identify these costs and explain why you are resubmitting them:
D.
NO
4
Except for any contractual relationship established in response to this remediation, is there any relationship -
personal, financial, or otherwise - between Applicant and any company or person who performed work for
which reimbursement is claimed? If yes, explain:
,
NO
5
Has Applicant received, or does Applicant expect to receive, compensation for corrective action costs from
ANY source other than the Colorado Petroleum Storage Tank Fund, including lawsuits, settlements,
judgments, contributions from other parties? If yes, state amount of other reimbursement:
$ . Identify source of reimbursement, including court case name and number,
,
NO
if applicable:
S^.{, ,, � k J 7 i14L 3RIF)
provlcl t 4t or it ) ti > 13 jiti i 1 tt # sine ti5 t11�+ i woe '
6
Do any costs claimed for reimbursement represent work performed by the Applicant or Applicant's
employees? If yes, submit the Affidavits Regarding Work Performed by Applicant.
NO
7
g
Has the Legal Name, Remit Entity or Address, Mailing Address or Tax Payer Identification Number changed
since the submittal of the Original or last Supplemental Reimbursement Application? If so, please submit a W-
9 (scanned signature is acceptable) - see Completing App Instructions tab.
NO
No
W-9 - If you answered yes to question 7, attach a W-9 to this application and explain any changes here.
Revised 4/18/24
'Prior versions of this application will na be accepted Page 2 of 4
By submitting this appitation, the Applicant affirms and agrees that:
1. The Applicant certifies; ender penalty of law, that Applicant is the appropriate person to request reimbursement, and that this document and all
attachments were prepared under Applicant's direction or supervision in accordance with a system designed to assure that qualified personnel properly
gathered and evaluated the information submitted.
2. The Applicant is the over/operator or duly authorized agent of the owner/operator responsible for this Site. The Applicant is and shall be responsible for
assuring compliance wth all applicable State and federal regulations.
3. The information submitted by the Applicant, to the best of Applicant's knowledge and belief, is true, accurate and complete. Applicant understands that
this application will be submitted by the Colorado Department of Labor and Employment (CDLE or State) for consideration by the Petroleum Storage Tank
Committee (Committee). Upon demand by the Committee, Applicant agrees to return the entire award Applicant may receive or any other amount the
Committee considers appropriate if (a) Applicant misrepresented or omitted any fad, either in writing or orally, relevant to the determinations made by
the Committee or the C.DLE; or (b) Applicant fails to complete, to the Committee's or the CDLE's satisfaction, the corrective action.
4. The Applicant shall not be entitled to obtain any other reimbursement from any source other than the State for the same costs or work reimbursed by the
State. Any reimbursement the Applicant receives or is entitled to receive, including insurance proceeds, is and shall be the property of the State of
Colorado to the extent of payments) made to the Applicant by the State from the Petroleum Storage Tank Fund. Upon receipt of any such
reimbursement from a source other than the State, Applicant shall immediately report and pay such reimbursement to the State.
5. To the extent payment is made from the Petroleum Storage Tank Fund, the Applicant hereby assigns to the State of Colorado any rights the Applicant may
have which may allow the Applicant to seek and obtain recovery from any other entity for the costs or work reimbursed by the State, including the right
to recover from insuraece companies.
6. The Applicant shall not submit any further claims for reimbursement from the State for the Site(s) and wort( identified in this application, other than an
amendment to the application or protest of the Fund Payment Report, if any, for work not heretofore reimbursed.
7. Applicant shall indemnify, save, and hold harmless the State, its employees and agents, and the Committee against any and all claims, damages, liability
and court awards including costs, expenses, and attomey fees and related costs, incurred as a result of any ad, omission or misrepresentation by the
Applicant, or its employees, agents, subcontractors, or assignees pursuant to the terms of this application.
As to governmental entity Applicants, no term or condition of this application shall be construed or interpreted as a waiver, express or implied, of any of
the immunities, rights, benefits, protection, or other provisions, of the Colorado Govenmemtal Immunity Act, CRS 24-10-101 et seq., or the Federal Tort
Claims Act, 28 USC 2671 et seq., as applicable, as now or hereafter amended.
8. In addition to any other legal rights the State of Colorado may have, the State shall have audit and on -site inspection rights for 3 years after payment.
9. The remediation services and supplies for which expenses are listed in this application were performed and/or purchased at the most reasonable rates
available for compliance.
10. The Applicant shall provide all formal or informal emrironmental assessment information to any future owner upon request.
11. In the event the Applicant breaches arty of the terra, conditions or requirements of this application , the State of Colorado, in addition to any other
remedies, at law or a arity, shall be entitled to immediate repayment on demand of aU amounts paid to the Applicant; and in the event that the State is
required to take legal action to enforce any of the provisions contained herein, the State shall be entitled, in addition to damages, to its costs and
reasonable attomey fees and related expenses incurred in connection with such enforcement.
12. At all times during the perfomance of this remediatioh, the Applicant shall strictly where to all applicable federal and state laws, rules and regulations
that have been or maytereafter be established, including without limitation 42 USC 6991 and CRS 8-20.5-101, et seq., and associated regulations.
13. The State may allocate more or less funds to the remediation described in this Application than the amount requested by the Applicant. Once the
reimbursement request is approved, the State will issue a Fund Payment Report, substantially in the form of Exhibit B, documenting the amount that will
be processed and paid.
14. The Committee has the authority and the right to designate funds be paid to Applicants on pro -rata basis when the Petroleum Storage Tank Fund balance
prevents payment in full, pursuant to CRS 8-20.5-206(e)(2).
15. Each additional request by Applicant for reimbtusement from the Petroleum Storage Tank Fund must be submitted on a new supplemental application.
Any additional paymert by the State shall be conditioned upon the issuance by the Committee of a new Fund Payment Repot for payment.
16. Pursuant to 7 CCR 1101-14, Article 8, the Applicant may file a protest of the Ftmd Payment Report if the Applicant disputes a decision by the Committee,
as stated on the Fund Payment Report. The Applicant may petition the Committee to review its decision. A Protest must be submitted within 60 days of
the date of the Fund Payment Report. See 7 CCR 1101-14, 8-6. The Applicant shall use the form of Protest of Fund Payment Report provided by the
Division of Oil and Public Safety of the Colorado Department of Labor and Employment
17. The maximum amount to be paid by the State, if any, in connection with this reimbursement request shall be authorized by the Committee in the Fund
Payment Report.
18. The payment by the State and acceptance by the Applicant of any reimbursement amounts requested under this application shall be deemed to be good
and sufficient consideration for the promises, certifications and affirmations made by Applicant in this Application.
Revised 4/18124
*Prior versions of this application wt. be accepted Pape 3 of 4
i
Signatory Page
i
Applicant:
Weld County Government
Legal Name of Applicant
84-6000813
Socia curity Number o EIN
gnature ofplicant or Authorized Officer
Perry L. Buck, Chair, Board of Weld County Cyr sioners
Print NampyTitle of Autbgrized icer
Attest: r� G*• u..46;t/i
Esther E. Gesick, Clerk to the Board
By.
Deput
e Boar CW
Complete if this is a replacement signatory page
PREQ/!
APR 2 1 2025
Date
FACILITY BM
EMAIL TO:
If you have any questions please consult the OPS website
cdle PSTReimbursementAppsCa7state.co.us and/or contact OPS at (303) 318-8525.
OPS website: https://ops.colorado.00v/
Revised 4/18/24
'Prior versions of this application will not be accepted Page 4 of 4
2oZ5-10015
COLORADO PETROLEUM
STORAGE TANK FUND
Photocopy additional pages as necessary
LISTING OF COSTS
Primary Invoice fil
Contractor Name
Dates of Work'
rothodxx nochochoc
Beginning Ending
Pinof of Payment
Invoice Amount
Amount Submitted
for Reimbursement°
Canceled Check.
°thee
Check III
Check Amt
535878
Palmetto
11/8/24
3127/25
AFF
$11,484.79
$11,484.79
TOTAL SUBMITTED FOR REIMBURSEMENT CONSIDERATION: $11,484.
List all PRIMARY invoices. If invoice does not dearly Identify work performed, add that information to the invoice copy submitted with the application.
List invoices in order by the date of work performed
If proof of payment is by canceled check, back of canceled checc is also required if the dollar amount is not encoded by the bank on the front of the check.
H proof of payment is by payee affidavit or CPA Certification, use fonowing codes: AFF = Affidavit CPA = CPA Certification of Payment. Use COLE Forms.
List only ALLOWwaE costs. If amount requested differs from invoice amount, identify on the invoice any cost for which reimbursement is NOT requested.
W/
&;:
PALMETTO
ENVIRONMENTAL GROUP LLC
Affidavit; Proof of Payment
(Revised 1/5/2016)
This form should be used when an applicant submits an affidavit as proof of payment for costs claimed for reimbursement. This
form is not required if copies of canceled checks or other bank confirmations of payment are provided.
Please note the following requirements.
• This form must be reproduced on the company letterhead of the payee (not the applicant's letterhead).
o Affidavits that are not on the payee's letterhead will not be accepted.
• This form must be signed by the payee, not the applicant.
• Use a separate affidavit for each contractor.
• Do not use this form if there is any affiliation or relationship between the applicant and the payee.
More information is available in Section 8-2 (b) (2) of the Petroleum Storage Tank Regulations.
Applicant Information-
Applicant Name:
Weld County Government
Site Name:
Weld County Fueling Facility
Site Address:
1113 H Street
City: I Greeley I State: I CO I ZIP: 180632
Payee Information and Certification
Check the following, as appropriate.
® I, being first duly sworn upon oath and being of lawful age, state that the following invoices relative to the referenced
application for reimbursement from the Colorado Petroleum Storage Tank Fund have been paid in full by the applicant.
❑ I, being first duly swom upon oath and being of lawful age, state that the following invoices relative to the referenced
application for reimbursement from the Colorado Petroleum Storage Tank Fund will be paid in full by the applicant upon
receipt of the reimbursement in accordance with a promissory agreement.
o Provide a signed and notarized copy of the agreement.
Invoice #
Invoice Date
Amount Paid
Invoice #
Invoice Date
Amount Paid
535878
4/2/25
$11,484.79
• I further state that there is no relationship or affiliation between myself and the applicant.
• I hereby certify that the foregoing information is correct to the best of my knowledge, information and belief. I
understand there are severe civil and/or criminal penalties for any false statement or misrepresentation of a material
fact, knowing it to be false, or failing to disclose a material fad with the intent to defraud.
Signature: Date:
Printed Name: I John D. Drafts 1 Title: I Principal I Phone #:
303.825.8117
Company (Payee) Name: I Palmetto Environmental Group
Company (Payee) Mailing Address: 14995 York St
City: I Denver I State: I CO I ZIP: 180216
Notary Public Certification
Subscribed and sworn to before me in the county of , State of
this day of
Notary Public Printed Name:
Signature:
My Commission Expires:
(303) 825-8117 4995 York Street Denver, Colorado 80216
4
PETROWASTE
SOLUTIONS
INVOICE
Job Name:
Weld County Fueling Facility
1113 H St Greeley, CO 80832
Description of Work: Purge Water Removal
Release #:
12712
Invoice Date:
Invoice #
11/7/2024
110724-12712
Item
Mileage
Travel Time
Professional Time
Misc. Field Supplies
Mileage DOT Truck
Travel Time
On -Site Time
Vacuum Trailer
Water Disposal
AS/SVE Pilot Test Skid
55 Gallon Waste Oil Drum
$ 0.62
$ 85.00
$ 89.00
$ 25.00
$ 2.75
$ 85.00
$ 85.00
$ 110.00
$ 0.85
Utit Amours€
Miles
Hours
Hours
Day
Miles
Hours
Hours
Hours
Gallons
$ 1,300.00 Day
$ 100.00 Drum
Manifest & HaIdling Fee $ 45.00 Lump
Waste Manifest #: 2175
55
Reimtiirsement
O ides
9.4
5.6
5.6
12.1
9.4
13.99
13.99
13.99
11.5
14.2
14.2
Total
$ 89.00
$
$ 46.75
11.99 $ 45.00
Total Due $ 180.75
C�
PETR()W1STE
NON -HAZARDOUS WASTE MANIFEST 21.75
i1.
Generator's US EPA ID Number Manrfest Document Number 2. Page 1 of
F-
W
Z
W
C7
3. Generator's Name and Mailing Address
4. Phone ( )
5. Generating Location Of different)
6 Phone ( )
7. Transporter #1 Company Name
8. US EPA ID Number
9. Transporter #1's Phone:
10. Transporter #2 Company Name
11. US EPA ID Number
12. Transporter #2's Phone:
13. Designated T/S/D Facility Name and Site Address
Petro Waste Solutions
4995 York Street, Suite B
Denver, CO 80216
14. US EPA ID Number
CO52329-10798
15. Facility's Phone
(303) 356-2645
16. Waste Shipping Name and Description
17InEMIZIN
19. Total
20 Unit
®' ®'
Quantity
Wt/Vol
a.
Unleaded Gasoline Contaminated Water
Gallons
b.
Diesel Contaminated Water
Gallons
d
21. Additional Descriptions for Materials Listed Above:
22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION: I certify the matierals descnbed on this mnandest are not subject to federai regulations for reporting and proper disposal of Hazardous Waste.
Printed/Typed Name Signature Month Day Year
CC
iPrinted/Typed
N
Z
q
¢H
24. Transporter #1: Acknowledgement of Receipt of Materials
Name Signature Month Day Year
25. Transporter #1: Acknowledgement of Receipt of Materials
Printed/Typed Name Signature Month Day Year
}
f —
J
Q27.
LL
tJ
,;(12.,N
26. Discrepancy Indication Space
Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest (except as noted in Item 19)
Printed/Typed Name Signature Month Day Year
T/S/D/P DOPY
ace®
Sold To:
Accou. Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825$117 x107
INVOICE
Pace Analytical Services, LLC 41-1821817
Pace Analytical National 82-0814289
Paco Analytical Services, LLC
9808 Lotret Blvd.
Lenexa, KS 88219
Phone: (913)599-5665
Date:
11/20/2024
Invoice k:
2460217162
Customer POOP:
14027
Terms:
Net 30
Due Date:
12/20/2024
Total Due:
$1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
60-533532 / Palmetto
14027
Heather Wilson
Client Prole. 1113 H St
Pace Project Ne: 60464463
Report Sent Tit:John Drafts, Palmetto Environmental
Comments:
Client Name: Palmetto
Sample Received 11/13/2024
Quantity Unk Description
ANALYTICAL CHARGES
Method Matrix
Price Total
11 Ea 80158 TPH-DRO
11 Ea 8260 IASV GRO and BTEX
EPA 80158 Water
EPA 8260 Water
$90.00 $990.00
$75.00 $825.00
Analytical Subtotal $1,815.00
Samples Received for analysis:
Lab ID Cient Sample ID
60464463001 MN-03RR
60464483002 MN -13
60464483003 MIN -14
60464463004 IW1f-15
60464463005 Mill -16
60464463006 M I-17
60464463007 NON -18
60464463008 MW -19
80464463009 MW -20
60464463010 MN -21
80464463011 MIN -22
Total Number of Charges 22
Received
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
11/13/2024 8:50:00
Total Invoice Amount $1,815.00
A CREDIT CARD SURCHARGE OF UP TO 3% MAY BE ADDED TO ANY PAYMENTS MADE VIA CREDIT CARD. Pep° 1' 2
'.1.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
AN EQUAL OPPORTUNITY EMPLOYER
Please complete and retum copy of invoice with your payment.
INVOICE TOTAL $1,815.00
Amount Paid: $
Check No:
Customer No: 60-533532 Invoice No: 246 021 71 62
Cc 1II1hY
Pace.
Sold To:
Accounts Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LLC 41-1821817
Pace Analytical National 82-0814289
Pace Analytical Services, LLC
9808 Loiret Blvd.
Lenexa, KS 88219
Phone: (913)599-6665
Date:
11/20/2024
Invoice #:
2460217162
Customer PON:
14027
Terms:
Net 30
Due Date:
12/20/2024
Total Due:
$1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
60-533582 / Palmetto
14027 1 Heather Wilson
Net 30
Client Project 1113 H St
Pace Project No: 60464463
Report Sent To: John Drafts, Palmetto Environmental
Comments:
Client Name: Palmetto
Sample Received: 11/13/2024
N you have any questions, please contact Heather Wilson et Pace.
Phone: 1(913)563-1407 Email: heatherwitson®pecetebs.com
A CREDIT CARD SURCHARGE OF UP TO 3% MAY BE ADDED TO ANY PAYMENTS MADE VIA CREDIT CARD. P+9e 2 of 2
.9.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
AN EQUAL OPPORTUMTY EMPLOYER
Nwestco LLC
Palmetto
4995 York Street
Denver, CO 80216
(303) 825-8117
Bill To:
Weld County Government
1105 H Street
PO Box 758
Greeley CO 80632
United States
Ship To:
Weld County Government
1105 H Street
PO Box 758
Greeley CO 80632
United States
Shipping Date:4/2/2025
INVOICE
PALMETTO
EN V igONMENT4L
An Nwes[co Company
Invoice # INV535878
Invoice Date 4/2/2025
Due Date 6/1/2025
Terms Net 60
PO#
Work Order#
Customer Weld County
Government
Amount Due $11,484.79
Item
Description
QtY
Rate
Amount
Tax
Environmental Billing
Fees
Environmental Billing Fees, See attached sheet
for detail.
$11,484.79
$11,484.79
11/6/24 to 3/27/25
Subtotal:
Discounts:
Sales Tax:
Payment:
$11,484.79
$0.00
($0.00)
Amount Due:
$11,484.79
Problem Notes
Solution Notes
EID:14027
Release #12712
1 of 1
Palmetto Environmental RCR Ibr Rel 12712 -11.6-24 to 3-27-25 REP a:
Clknt Name:
Billing Addreu:
CRy, Stak, Z p:
91te Name:
SRe Addrps
CRy, Skk, Z p:
Rekaae 5:
NAM Count, Dept of PublicPublic...Erg.
PO Bex 758
CrakY. CO 80632
NAM Goum, Fueling Fecility
Lek'173H fit
Ss, CO130632
1512
Start bete:
26
t1/62024 End Date:
3/272025
CONSULTANT
INVOICE e
suTTMGTO7
INVOICE•
SeBCGTO
R NAAEONTRA
EMPLOYEE NAME
OATS OF
WDRN
0
O
u
Y
g
0
6�
TASK OR LABOR CODE (TLC)
TASK DESCRIPTIOI
5
J
5'
b
gx
3
535878
Chris Bird
11/62024
3G
o.
5.3
hours
0.50
5155.00
$77.50
$77.50
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
Chns Chapman
Ch. Chapman
Chris Chapman
Chris Bird
11/62024
11/82024
11862024
11/7/2024
11/70024
11/72024
11/70024
11/70024
11/70024
11/72024
11/72024
11/72024
3G
3G
3G
3G
3G
3G
3G
3G
3G
3G
9
9
5.5
66
5.6
5.6
5.6
11.99
11.5
4.1
5.6
9.4
6.7
6.3
5.3
Senior Technician - Sample proF
Samar technician - travel, decon.
Cot
Senior technician - travel, decon.
hours
hours
hours
hours
hours
each
gallons
wean
hour
mlea
samples
mamba
hours
0.50
0.50
1.00
3.50
3.50
1.00
5114.00
589.00
$89.00
588.00
$45.00
$57.00
544.50
589.00
$311.50
$311.50
557.00
544.50
589.00
5311.50
5311.50
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
535878
110724-12712
110724-12712
110724-12712
2480217182
2460217182
P�roWask
PetroWaste
PdroWaste
PACE
PACE
Michsel Crachley
John Drafta
John Drafts
Chris Bird
Chris Bird
Drew Mulford
Drew Mulford
Drew Mulford
11/110024
1127/2024
12/30024
12/30024
3/612025
3/170025
3/170025
3/170025
3/18/2025
3/182025
3/180025
3/182025
Chris fled
Jahn Drafts
3/182025
3/182025
3/180025
3242025
3242025
3G
3G
3G
3G
3G
3H
3H
3H
3H
3H
3H
3H
3H
311
3H
3H
3H
3G
A
A
9
9
9
9
9
9
9
h.
h.
h.
h.
h.
h.
h.
h.
h.
h.
5.2
5.2
7.1
5.3
5.3
5.6
5.6
12.1
12.2
13.18
2.5
5.6
5.3
7.5
5.2
Manifest end ...ding fee
Waate disposal
Sample wells
Profeemonal time
Mileage
BTEX/TVPH
TEPH
Protect Manager • COC review
REP Time - sample data •view for
NFA
REP Time - final MRR-NF le review
MRR - nt system; semiamiva
Project Manager - Abandonment
packet for DM
Project Manager-abantlonmen
pbnning cenversaticn wN ON
fienior teehmeian - abandenment
planning conversatlen w/ CB
Senior technican -
abandonmenlprep
Womb... field ...palms
Depth to water
Treffic control
Well abandonment
fienior technician - Well
abandonmem event, 11 CiN wells,
travel
Mileage
Project Manager - ET'
decommissionnp repaNsuh
Site decommissioning report
hours
hours
report
hours
hours
hours
day
dey
day
feet
hours
miles
hours
report
hours
55.00
11.00
too
117.00
11.00
11.00
0.25
0.75
1.50
1.00
0.50
0.50
0.50
0.50
too
too
1.00
165.00
7.50
117.00
0.75
1.00
0.25
50.85
5132.00
589.00
50.67
$75.00
soo.00
$155.00
5168.00
$168.00
$3,163.00
5155.00
$155.00
589.00
$89.00
$12.00
525.00
525.00
58.50
$89.00
$0.70
$155.00
S300.o0
$168.00
545.00
546.75
51 ,452.00
Sato°
578.39
5825.00
5990.00
$38.75
$125.00
$252.00
$3,163.00
577.50
$77.50
544.50
.1.50
512.00
$25.00
$25.00
51,402.50
5667.50
581.90
5115.25
$300.00
$123.75
5145.50
$45.00
548.75
51,452.00
Seam
$78.39
5948.75
$1,138.50
$38.75
5126.00
$252.00
$3,163.00
577.50
$77.50
$44.50
544.50
$12.00
525.00
$25.00
51,402.50
$687.50
542.00
$81.90
$116.25
5300.00
542.00
535878
535878
Chris Bird
Katie Drafts
3/242025
3/27/2025
3H
3H
h.
h.
5.3
5.9
Project Manager-DYMt terms end
ACandonment report rwsion
Clerical - final pap...1, fihns
hours
hours
1.50
5155.00
587.00
5232.50
587.00
5232.50
587.00
511,484.79
.,� Colorado Department of Labor and Employment
'? Division of Oil and Public Safety - Remediation Section
. ` 63317"' Street, Suite 500
. • ` Denver, CO 80202-3610
Release Information
Event ID#:
14027 Release ID#: REL-012712
Facility ID#:
271
Release Name:
Weld County Fueling Facility
Dates of work:
3/18/25
Facility Address
street:
1113 H Street
City:
Greeley I ZIP CODE: 180632
REP/Consultant and Company:
Palmetto Environmental Group, LLC
Wells (includes vapor points, AS or SVE points, extraction/injection/recovery wells, etc.)
Abandon"all wells in accordance with Colorado Division ¢Water Resources (DWR) requirements.
List wells abandoned,
footage, and total footage
(e.g MW -1 (20 ft]):
MW-03RR [15 ft], MW -13 [15 ft], MW -14 [15 ft], MW -15 [15 ft], MW -16 [15 ft],
MW -17 [15 ft], MW -18 [15 ft], MW -19 [15 ft], MW -20 [15 ft], MW -21 [15 ft],
MW -22 [15 ft]
TOTAL FOOTAGE: 165 ft
The DWR has been notified that registered wells have been abandoned: I Yes® I No®
List wells retained (if
applicable):
Remediation Equipment
Has equipment been removed
from wells?
Yes®
No®
If not removed, why?
N/A
Has equipment housing or shed
been removed?
YesO
No®
If not removed, why?
N/A
Has equipment from within
housing or shed been removed?
Yeso
N'‘.7—.../
If not removed, specify
which equipment was
left behind and explain
why.
N/A
Status of underground system pip'ng (e.g. removed, left
in place ends tapped, left in place slurry filled, etc.):
N/A
Derived Waste
Has all waste resulting from assessment and remedial efforts been removed from the site? I Yes ® N°O
If not removed, explain why, the
schedule for removal, and who is
responsible for removal.
Requested Attachments: Site map showing well locations and system layout for reference, applicable Division of
Water Resources Well Abandonment forms and Well Change of Owner forms, boring logs of wells retained, any
additional attachments to provide complete explanations or information, as needed.
Colorado Division of Oil and Public Safety
Release Event Decommissioning Form Page 1 of 1
Contract Form
Entity Information
Entity Name* Entity ID*
PALMETTO ENVIRONMENTAL @00034965
GROUP LLC
Contract Name* Contract ID
COLORADO PETRCLEUM TANK STORAGE FUND 9357
REIMBURSEMENT APPLICATION
Contract Status
CTB REVIEW
Contract Lead*
RWILLIAMS
O New Entity?
Parent Contract ID
Requires Board Approval
YES
Contract Lead Email Department Project #
rwi I I iams@weld.gov; cpatt
elli@weld.gov
Contract Description*
THE PALMETTO GROUP HAS COMPLETED SOME ENVIRONMENTAL CLEANUP AT THE GREELEY FUEL SITE. THE
COST OF THEIR SERVICE IS ELIGIBLE TO BE REIMBURSED BY THE COLORADO STORAGE TANK FUND. THIS ITEM IS
THE APPLICATION FOR THAT REIMBURSEMENT.
Contract Description 2
Contract Type*
AGREEMENT
Amount*
$11,484.79
Renewable*
NO
Automatic Renewal
Grant
IGA
Department
ACCOUNTING
Department Email
CM-
Accounting@weld.gov
Department Head Email
CM-Accounting-
DeptHead@weld.gov
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
Requested BOCC Agenda Due Date
Date* 04/12/2025
04/16/2025
Will awork session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
12/31/2025
Committed Delivery Date
Renewal Date
Expiration Date*
12/31/2025
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
RUSTY WILLIAMS CHERYL PATTELLI BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
04/15/2025 04/16/2025 04/16/2025
Final Approval
BOCC Approved Tyler Ref #
AG 042125
BOCC Signed Date Originator
RWILLIAMS
BOCC Agenda Date
04/21/2025
Hello