HomeMy WebLinkAbout20250521.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 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 (ps /1a), AcT(p/Rte/GD)
0212V25
2025-0521
AC0023
FT0004
BG0027
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 24th day of February, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppier: Aye
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
2025-0521
AC0023
FT0004
BG0027
Con,hcoLc+1S `115
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS AROUND TITLE: Colorado Petroleum Tank Storage Fund Reimbursement
DEPARTMENT: Accounting/Fleet Services DATE: February 7, 2025
PERSON REQUESTING: Rusty Williams/David Springer
Brief description of the problem/issue:
During construction work on the Greeley fuel site in 2021 there was contamination found under the site. The
Palmetto Environmental Group (Palmetto) was hired to clean up 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 am eligible for reimbursement from the Colorado Petroleum Storage Tank Fund.
The work completed in 2024 by Palmetto totaled $18,800.98. 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 for
the cost of the cleanup. The reimbursement request is $18,800.98.
The board signed similar requests for Palmetto in 2021, 2022, and 2023.
What options exist for the Board?
Signing the request will reimburse the county for the $18,800.98 costs incurred for the cleanup.
Consequences:
Impacts:
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
Recommendation:
We reconxnend the board sign the request to receive the reimbursement.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
Jd.
2025-0521
fi LOOM
FT 00134
1 Z-1
COLORADO PETROLEUM STORAGE TANK SUPPLEMENTAL REIMBURSEMENT APPLICATION
FUND Short Form S (2024)
This form should be used, and can only be used, on Supplemental Reimbursement Applications when the PREQ #
Applicant has already established eligibility for reimbursement of remediation costs relative to this occurrence. c01E/ops
Internal Use only
The nature of this Supplemental Reimbursement Application is: [Select all that apply]
Additional costs not previously reimbursed. , X
Other (Explain):
List PREQ# of last application previously filed for this remediation:
46030
Applicant's Full
Legal Name:
Weld Count Government
y
Social Security # or Federal
Tax ID #
84-6000813
Contact Person:
Chris D'Ovidio
Phone # 970.400.4445
Fax #
Mailing Address:
Street: 115O O Street
Email: cdovidioa@weldgov.com
City: Greeley State CO ##
Reimbursement
Mailing Address
(if different) :
Remit Entity:
Street:
City: State Zip Email
Applicant is (select one): , Government
Other:
Site Name:
Weld County Fueling Facility
Site Address:
Street: 1113 H Street
City: Greeley State CO Zip 80632
Complete this section only if you want the representative to be the primary contact and copied on all
correspondence.
Applicant's
Representative
(if applicable)
Name Palmetto Environmental Group
Address 4995 York St.
Email:
palmetto. generhQnwestco.com
City Denver State CO ZIP 80216
Phone #
Fax #
303.825.8117
Total from Listing of Costs, last column:
$18,800.98
Less reimbursement from any other source (see #5):
NET REIMBURSEMENT REQUEST:
$18,800.98
Dates of work covered by this application: From: 2/624 To:
8/8/24
For OPS Use Only
Facility ID:
Type:
Date Received by OPS
Release 0:
Technical Reviewer:
Last PREQ:
Fund Analyst:
OPS
Revisions
Revised From Date Revised To Date
Amount After Converted
Revised 4/18/24
'Prior versions of this application will not be accepted
Page 1 of 4
REIMBURSEMENT INFORMATION
1
Will there be additional reimbursement applications for this release?
Yes
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:
Note: If there have been any changes to insurance from that submitted with the Original Application,
provide updated information with this Application (in the same format as the Original Application).
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
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 not be accepted Page 2 of 4
By submitting this application, the Applicant affirms and agrees that:
1. The Applicant certifies, under 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 owner/operator or duly authorized agent of the owner/operator responsible for this Site. The Applicant is and shalt be responsible for
assuring compliance with 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 tfie entire award Applicant may receive or any other amount the
Committee considers appropriate if (a) Applicant misrepresented or omitted any fact, ether in writing or orally, relevant to the determinations made by
the Committee or the CDLE; 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 payment(s) 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 far the costs or work reimbursed by the State, including the right
to recover from insurance companies.
6. The Applicant shall not submit any further claims for reimbursement from the State for the Site(s) and work 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 attorney fees and related costs, incurred as a result of any act, omission or misrepresentation by the
Applicant, or its employees, agents, subcontractors, or assignees pursuant to the terms of this application.
As to govemmental 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 Governmental 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 environmental assessment information to any future owner upon request.
11. In the event the Applicant breaches any of the teens, conditions or requirements of this application , the State of Colorado, in addition to any other
remedies, at law or equity, shall be entitled to immediate repayment on demand of all 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 attorney fees and related expenses incurred in connection with such enforcement.
12. At all times during the performance of this remediation, the Applicant shall strictly adhere to all applicable federal and state laws, mks and regulations
that have been or may hereafter 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 8, documenting the amount that wilt
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 reimbursement from the Petroleum Storage Tank Fund must be submitted on a new supplemental application.
Any additional payment by the State shall be conditioned upon the issuance by the Committee of a new Fund Payment Report for payment.
16. Pursuant to 7 CCR 1101-14, Article 8, the Applicant may file a protest of the Fund 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 4/18/24
*Prior versions of this application will not be accepted Page 3 of 4
Signatory Page
Applci a :
Weld County Government
Legal Name of Applicant
84-6000813
Social Security Number or FEIN
Signature of/Applican or Authorized Officer
Perry L. Buck, Chair - Board of Weld County Corn
Print Name 8 Title of Authorized Officer
Attest: 1�,
Esther E. esick,/Clerk to the Board
Deputy lerk to the Boar'd V l
Complete if this is a replacement signatory page
PREQ#
FEB 2 4 2025
Date
FACILITY ID#
EMAIL TO:
If you have any questions please consult the OPS website
cdle PSTReimbursementAppsSstate.co.us and/or contact OPS at (303) 318-8525.
OPS website: hops://ops.colorado.00v/
Revised 4/18/24
`Prior versions of this application will not be accepted
Page 4 of 4
COLORADO PETROLEUM
STORAGE TANK FUND
Photocopy additional pages as necessary
LISTING OF COSTS
Primary Invoice #'
Contractor Name
Dates of Workz
xx/xx/xx xx/xx/xx
Beginning Ending
Proof of Payment
Invoice Amount
Amount Submitted
for Reimbursement'
Canceled Check'
Other°
Check #
Check Amt
524928
Palmetto
2/6/24
8/8/24
AFF
$18.800.98
$18,800.98
TOTAL SUBMITTED FOR REIMBURSEMENT CONSIDERATION:
List all PRIMARY invoices. If invoice does not clearly 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 check is also required if the dollar amount is not encoded by the bank on the front of the check.
If proof of payment is by payee affidavit or CPA Certification, use following codes: AFF = Affidavit. CPA = CPA Certification of Payment. Use CDLE Forms.
List only ALLOWABLE costs. If amount requested differs from invoice amount, identify on the invoice any cost for which reimbursement is NOT requested.
$18,800.98
PA
PALMETTO
EMVIROMMENTAL 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 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 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
524928
12/3124
$18,800.98
• 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 fact with the intent to defraud.
Signature: Date:
Printed Name: John D. Drafts I Tide: I Principal I Phone #:
303.825.8117
Company (Payee) Name: 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 a 4995 York Street a Denver, Colorado 80216
PETRoW\sTE
GENERATOR
TRANSPORTER
1 Generator's US EPA ID Number
NON -HAZARDOUS WASTE MANIFEST
Manifest Document Number
2 Page 1 of
Generator's Name and Mailing Address
4 Phone (
I. Transporter #1 Company Name
10 Transporter #2 Company Name
13. Designated T/S/D Facility Name and Site Address
Petro Waste Solutions
4995 York Street, Suite B
Denver, CO 80216
7i1n
5. Generatiig Location (if different)
6 Phone (
8. US EPA ID Number
11. US EPA ID Numbe
14. US EPA ID Number
CO52329-10798
16. Waste Shipping Name and Description
Unleaded Gasoline Contaminated Water
Diesel Contaminated Water
17
9. Transporter #1's Phone:
12 Transporter #2's Phone:
15 Facility's Phone
(303) 356-2645
18. Containers
No.
Type
19 Total
Quantity
20. Unit
Wt/Vol
Gallons
Gallons
:1 Additional Descriptions for Materials Listed Above:
22. Special Handling Instructions and Additional Information
23 GENERATOR'S CERTIFICATION: I certify the matierats described on this manifest are not subject to federal regulations for reporting and proper disposal of Hazardous Waste.
Printed/Typed Name
24. Transporter #1: Acknowledgement of Receipt of Materials
Printed/Typed Name
Signature
Month1 Da;
I I Year
25. Transporter #1 Acknowledgement of Receipt of Material
Printed/Typed Name
Signature
Day Year
l 'Month
26. Discrepancy Indication Space
27 Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest (except as noted in Item 19)
Printed/Typed Name
Signatu-e
Month Day Year
T/S/DfcCQPY
I'I's'SI(1)(U3'';'
PETROWASTE
SOLUTIONS
Job Name:
Description of Work:
Release #:
INVOICE
Weld County Dept of Public Works Eng. Invoice Date:
1113 H St. Greeley, CO 80632 Invoice #
Purge Water Removal
12712
2/15/2024
21524-12712
1
Rate
Unit
Amount
Reimbursement
Codes
Total
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
Manifest & Handling Fee
Waste Manifest #: 2110
0.62
85.00
89.00
25.00
2.75
85.00
85.00
110.00
0.85
$ 1,300.00
$ 85.00
$ 45.00
Miles
Hours
Hours
Day
Miles
Hours
Hours
Hours
Gallons
Day
Drum
Lump
1
47.5
1
9.4
5.6
5.6
12.1
9A $
13.99
13.99
13.99
11.5
14.2
14.2
11.99
Total Due
$
85.00
40.38
$
$ 45.00
$ 170.38
ace
Sold To:
Accounts Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LLC 41-1821617
Pace Analytical National 62-0814289
Pace Analytical Gulf Coast 45-4027089
Pace Analytical Services, LLC
9608 loiret Blvd.
Lenexa, KS 66219
Phone: (913)599-5665
Date:
02/22/2024
Invoice #:
2460201442
Customer PO#:
Terms:
Net 30 Days
Due Date:
03/23/2024
Total Due:
$1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Client Number/Client /D
60-533532 / Palmetto
Purchase Order No
Pace Project Mgr
Heather Wilson
Terms'"
Net 30 Days
Page
Client Project: 1113 H STREET
Pace Project No: 60447401
Report Sent To: John Drafts, Palmetto Environmental
Comments:
Client Name: Palmetto
Sample Received: 2/19/2024
Quantity Unit Description
ANALYTICAL CHARGES
Method Matrix
Price Total
11 Ea 80158 TPH-DRO
11 Ea 8260 MSV 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 Client Sample ID
Total Number of Charges 22 Total Invoice Amount $1,815.00
Received
60447401001 M N-03RR
60447401002 MW -13
60447401003 MW -14
60447401004 MW -15
60447401005 MW -16
60447401006 MW -17
60447401007 MW -18
60447401008 MW -19
60447401009 MW -20
60447401010 MW -21
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
2/19/2024 8:45:00
249/2024 8:45:00
If paying by credit card, a 2.5% surcharge of $45.38 will be assessed, PAY $1.860 38
A 2.5% CREDIT CARD SURCHAGE OF $45.38 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT Page 1 of 2
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
"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 return copy of invoice with your payment.
INVOICE TOTAL $1,815.00
Amount Paid: $
Check No:
Customer No: 60-533532 Invoice No: 2460201442
cc_ z-(
Pace
Sold To:
Accounts Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LLC 41-1821617
Pace Analytical National 62-0814289
Pace Analytical Gulf Coast 45-4027089
Pace Analytical ServioLLC
9608 Loiret Blvd.
Lenexa, KS 66219
Phone (913)599-5665
Date:
02/22/2024
Invoice it:
2460201442
Customer P0#:
Terms:
Net 30 Days
Due Date:
03/23/2024
Total Due:
$1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Client Number/Client /D
60-533532 / Palmetto
Purchase Order No
Pace Project Mgr
Heather Wilson
Terms"*
Net 30 Days
Page
Client Project: 1113 H STREET
Pace Project No: 60447401
Report Sent To: John Drafts, Palmetto Environmental
Comments:
Samples Received for analysis;
Lab ID Client Sample ID
60447401011 MW -22
Client Name: Palmetto
Sample Received: 2/19/2024
Received
2/19/2024 8:45:00
If you have any questions, please contact Heather Wilson at Pace.
Phone: 1:913)563-1407 Emarl: heather.wilson@pacelabs.com
A 2.5% CREDIT CARD SURCHAGE OF $45.38 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
"'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
Page 2 of 2
WV
Customer ID:
Customer Name:
Service Period:
Invoice Date:
In\ nice Number:
Page 3 of 3
1-62687-24004
PALMETTO ENVIRONMENTAL
02/01/24-02/29/24
03/01/2024
0035366-1528-3
DETAILS OF SERVICE - continued
Details for Service Location:
Palmetto Environmental, 4995 York Street, Denver CO 80216-2245
Description
Ticket Total
Vehidet. BOOM BOX
PO#:105 S.MainFt.Nlorgon
Cont Soil - Petroleum
Haz -Substance Response Fee Drum
Profile # 13730103
Generator MIDWEST GAS & GROCERY (105 S MAIN ST)
Manifests. 12724194
Ticket Total
Vensaeu: BOOM BOX
PO# -1 3902-3192S ParkerAu
Cont. Soil - Petroleum
Hat -Substance Response Fee Drum
Profile # 132659C0
5 9CG
Generator KING SOOPERS FUEL 639
Manifests*: 12724193
Ticket Total
Veh;cte# BOOM BOX
PO#:320N.1 stStLaSatle
Cont. Sod - Petroleum
Haz-Substance Response Fee Drum
Profile # 125809C0
Generator LA SALLE OIL COMPANY (320 N 1ST ST)
Manifest's: 12724191
Ticket Total
Vehicle*: BOOM BOX
1113 1 1 3 HStGreel
Cont. Soil - Petroleum
Haz-Substance Response Fee Drum
Profile # 133099C0
Generatcr WELD COUNTY GOVERNMENT
Mart,fest# 12724195
Ticket Total
Late Payment Charge for 01/02/2024 Invoice 35241
Date
02/29/24
02/29/21
02/29/24
02/29/24
02/01/24
Ticket
181767
181768
181769
181 770
Customer ID:
Quantity
Unit of
Measure
00 ECH
2.00 ECH
3.00 ECH
4.00 ECH
1-62687-24004
Rate
155.00
114.49
114 49
1 1449
Amount
1
330.18
O.:.)
O 00
1,320.00
072
O 00
0.00
000
1,320.72
0 0u
0 00
228.98
0.18
0.00
0.00
0.00
229.16
O 00
0 00
343 47
0.27
0.00
0 00
0 00
343.74
0.00
0.00
457.96
0.36
O 00
0.00
O 00
458.32
22.58
Total Current Charges
2,804.70
Printed an
recycled paper.
WASTE MANAGEMENT
NON -HAZARDOUS MANIFEST
NON -HAZARDOUS MANIFEST
1. Generator's US EPA ID No. Manifest Doc No.
2. Page 1 of
3. Generator's Mailing Address:
Generator's Site Address (if different than mailing):
A. Manifest
WMNA
Number
12724195
B. State Generator's ID
4. Generator's Phone
5. Transporter 1 Company Name
6. US EPA ID Number
C. State Transporter's ID
D. Transporter's Phone
7. Transporter 2 Company Name
8. US EPA ID Number
E. State Transporter's ID
F. Transporter's Phone
G
E
N
E
R
A
T
O
R
9.
CONSERVATION
41800
BENNETT
Designated
E
88TH
CO
Facility
80102
AVE
SERVICES,
Name
and Site
INC
Address
10. US EPA ID Number
G. State Facility ID
H. State Facility Phone 303-644-4335
11. Description of Waste Materials
12 Containers
13 Tot 31
Quanti'y
14 Unit
Wt./Vol
I. Misc. Comments
No
Type
WM Profile #
-
b.
WM Profile #
c.
WM Profile #
REGULATORY
Colorado
4300
Denver,
Cherry
CO
Department
AGENCY:
Creek
80222-1530
Drive
of Public
South
Health
and Environment /
J.
ENVIRONMENTAL
Additional
ACCT:
Descriptions
CSI
-1020
GROUP
for
CUST
Materials
NAME:
LLC
Listed
Above
PALMETTO
K. Disposal Location
Cell
Level
Grid
15. Special
Handling Instructions
and Additional Information
Purchase Order tt EMERGENCY CONTACT
NO.: 1-800-424-9300
24HR
TOLL
FREE
/PHONE
16. GENERATOR'S CERTIFICATE:
I hereby certify that the above -described materials are not hazardous wastes as defined by CFR Part 261 or any applicable state law, have been fully
accurately described, classified and packaged and are in proper condition for transportation according to applicable regulations.
and
Printed Name
Signature "On behalf of"
I
fMlorth
Day I
Year
I
r
S
P
o
a
E
17. Transporter 1 Acknowledgement
of Receipt of Materials
Printed Name
Signature I
Month I
Day '
Year
18. Transporter 2 Acknowledgement of Receipt of Materials
P g P
Printed Name
Signature
Month
Day
Year
,
19. Certificate of Final Treatment/Disposal
I certify, on behalf of the above listed treatment facility, that to the best of my knowledge, the above -described waste was managed in compliance with all
applicable laws, regulations, permits and licenses on the dates listed above. -_
20. Facility Owner or Operator: Certification of receipt of non -hazardous materials covered by this manifest.
Printed Name
Signature
Mon•h
Day
Year
1
I
White- TREATMENT, STORAGE, DISPOSAL FACILITY COPY
Blue- GENERATOR #2 COPY
Yellow- GENERATOR #1 COPY
Pink- FACILITY USE ONLY
Gold- TRANSPORTER #1 COPY
Page 3 of 5
Customer ID:
Customer Name:
Service Period:
Invoice Date:
Invoice Number:
1-62687-24004
PALMETTO ENVIRONMENTAL
O4/O1/24-O4/3O/24
05/01/2024
0035500-1528-7
DETAILS
OF SERVICE
- continued
Details
Palmetto
for Service
Environmental,
Location:
4995 York Street,
Denver CO 80216-2245
Customer ID:
1-62687-24004
Description
Date
Ticket
Quantity
Unit of
Measure
Rate
Amount
Vehicle#: NONE
04/04/24
182146
0.00
Recertification Fee
1.00
ECH
35.00
35.00
Profile # 13286700
0.00
Generator AZ MART (34013 CR 13)
0.00
Ticket Total
35.00
Vehicle#: NONE
04/04/24
182147
0.00
Recertification Fee
1.00
ECH
35.00
35.00
Profile # 13309900
0.00
Generator WELD COUNTY GOVERNMENT
0.00
Ticket Total
35.00
Vehicle#: NONE
04/04/24
182148
0.00
Recertification Fee
1.00
ECH
35.00
35.00
Profile # 13297500
0.00
Generator OCTANE LLC
0.00
Ticket Total
35.00
Vehicle#: NONE
04/04/24
182149
0.00
Recertification Fee
1.00
ECH
35.00
35.00
Profile # 13600800
0.00
Generator WESTERN DISPOSAL INC (5880 BUTTE
0.00
MILL RD) !
Ticket Total
35.00
Vehicle#: NONE 104/05/24
182157
0.00
PROFILE PROCESSING FEE
1.00
ECH
50.00
50.00
Profile # 13751600
,
0.00
Generator PALMETTO ENVIRONMENTAL (289
S
0.00
GARRISON ST)
Ticket Total
50.00
Vehicle#: NONE
04/05/24
182158
0.00
PROFILE PROCESSING FEE
1.00
ECH
50.00
50.00
Profile # 13751700
0.00
Generator PALMETTO ENVIRONMENTAL (11185
0.00
RALSTON RD)
Ticket Total
50.00
Vehicle#: NONE
04/05/24
182160
0.00
PROFILE PROCESSING FEE
1.00
ECH
50.00
50.00
Profile # 13751800
0.00
Generator PALMETTO ENVIRONMENTAL (1039
CR
0.00
308)
Ticket Total
50.00
Vehicle#: BOOM BOX
04/12/24
182242
0.00
PO#:289S.GurrisonLakew
0.00
Cont. Soil - Petroleum
2.00
ECH
165.00
330.00
Haz-Substance Response Fee Drum
0.18
Profile # 13751600
0.00
Generator PALMETTO
ENVIRONMENTAL (289 S
0.00
GARRISON ST)
Manifest#: 12724210
0.00
Ticket Total
330.18
Vehicle#: BOOM BOX
04/12/24
182243
0.00
PO#:Octane
_ 0.00
Printed an
recycled paper.
C
PETROWASTE
SOLUTIONS
INVOICE
Job Name:
Description of Work:
Release #:
Weld County Dept of Public Works Eng. Invoice Date:
1113 H St. Greeley, CO 80632 Invoice #
Purge Water Removal
12712
5/10/2024
51024-12712
Item
Rate
Unit
Amount
Reimbursement
Codes
Total
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
Manifest & Handling Fee
Waste Manifest #: 2123
$
0.62
85.00
89.00
25.00
2.75
85.00
85.00
110.00
0.85
$ 1,300.00
$ 85.00
$ 45.00
Miles
Hours
Hours
Day
Miles
Hours
Hours
Hours
Gallons
Day
Drum
Lump
1
13.5
1
9.4
5.6
5.6
12.1
9.4
13.99
13.99
13.99
11.5
14.2
14.2 $
11.99
Total Due
85.00
11.48
$ 45.00
$ 141.48
L�
PETROWASTE
NON -HAZARDOUS WASTE MANIFEST
2123
1. Generator's US EPA ID Number
Manifest Document Number
2. Page 1 of
--
3� Gene
i ?
4 Phone
a
(
- is Npme
( C
)
and Mailing
Lir- (
Address
t V priti a.-- pt. b 1 c , iioik---
5. C
6. Phone
nerat_ng Location (if differ
Ili if-, I/ zi /.
)
t)
.2,
/ r , _
i / Lir ,,e_
7 Transporter #1
t17)1,�
Company
f -t01
oes
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
Petro Waste
4995 York
Denver, CO
Facility
Solutions
Street,
80216
Name and Site
Suite
Address
B
14. US EPA ID Number
0052329-10798
15.
Facility's Phone
(303) 356-2645
16. Waste Shipping Name and Description
I ;
18. Containers
19. Total
20. Unit
WWol
No
T,,
Quantity
a
Unleaded
Gasoline
Contaminated
Water
Gallons
Diesel
Contaminated
Water
Gallons
NERA1
Pviqeiitii-t-r (
(69/4 ,
21. Additional Descriptions for Materials Listed Above.
22. Special Handling
Instructions and Additional Information
23. GENERATOR'S CERTIFICATION:
I certify the matierals described on this mnanifest are not subject to federal regulations for reporting and proper disposal of Hazardous Waste.
Printed/Typed Name
i
111(14
1 17,11/7.1k),4
Signature
_
,. .,r —
I
Month
I
Day
I
Y ar
f
Ce
r"
W
24. Transporter #1: Acknowledgement of Receipt of Materials
Printed/Typed
Name
IP
!' P ! � /1\ tr' �/�Il1IIa.tn
Signature
Month
Day
Year
Z
25. Transporter
#1: ke
knowledgement of Receipt of Materials
_ ✓ ��
Printed/Typed Name
Signature
I<
Month
Day
Year
26. Discrepancy Indication Space
D/FACILI
27. Facility
Owner or Operator: Certification of receipt of waste materials
p P
covered by this manifest (except as noted in Item
( p 19)
Printed/Typed Name
T/S/D/F
Signature
COPY
Month
Day
Year
Sold To:
Accounts Payable
Palmett3 Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LLC 41-1821617
Pace Analytical National 62-0814289
Pace Analytical Gulf Coast 45-4027089
Pace Analytical Services, LLC
9608 Loiret Blvd.
Lenexa, KS 66219
Phone: (913)599-5665
Date:
05/16/2024
Invoice #: 1
2460206275
Customer PO#:
14027
Terms:
Net 30 Days
Due Date:
06/15/2024
Total Due:
$1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Client Number/Client ID
Purchase Order No
Pace Project Mgr
Heather Wilson
Terms**
Page
60-533532 / Palmetto
14027
Net 30 Days
1
Client Project: 1113 H St
Pace Project No: 60452713
Report Sent To: John Drafts, Palmetto Environmental
Comments:
Client Name: Palmetto
Sample Received: 5/11/2024
Quantity Unit Description
11 Ea 80156 TPH-DRO
11 Ea 8260 MSV GRO and BTEX
ANALYTICAL CHARGES
Method
EPA 8015B
EPA 8260
Matrix
Water
Water
Price
$90.00
$75.00
Total
$990.00
$825.00
Analytical Subtotal
$1,815.00
Samples Received for analysis:
Lab ID
Client Sample ID
Total Number of Charges 22
Received
60452713001
60452713002
60452713003
60452713004
60452713005
60452713006
60452713007
60452713008
60452713009
60452713010
MW-03RR
MW -13
MW -14
MW -15
MW -16
MW -17
MW -18
MW -19
MW -20
MW -21
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
5/11/2024 9:15:00
Total Invoice Amount
$1,815.00
If paying by credit card, a 2.5% surcharge of $45.38 will be assessed, PAY $1,860.38
A 2.5% CREDIT CARD SURCHARGE OF $45.38 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
}''`1.5% MONTHLY FINANCE CHARGE ASSESSED AFTER 30 DAYS OR TERMS OF CONTRACT.
PLEASE REFERENCE THE INVOICE NUMBER ON ALL REMITTANCE ADVICE.
Please complete and return copy of invoice with your payment.
INVOICE TOTAL $1,815.00
Amount Paid: $
Check No:
Customer No: 60-533532
Invoice No: 2460206275
Page 1 of 2
AN EQUAL OPPORTUNITY EMPLOYER
-3 1-i,
Pace
Sold To:
Accounts Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LLC 41-1821fi17
Pace Analytical National 620814289
Pace Analytical Gulf Coast 45-4027089
Pacer ArefalyNcal Services, -EL
9608 Lairet Blvd.
Lenexa, KS 66219
Phone: (913)599-5665
Date: 05/16/2024
Invoice #: 2460206275
Customer PO#: 14027
Terms: Net 30 Days
Due Date: 06/15/2024
Total Due: 51,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Client Number/Client ID
60-533532 / Palmetto
Purchase Order No I Pace Project Mgr
140 7 1 Heather Wilson
Terms"
Net 30 Days
Page
2
Client Project: 1113 H St
Pace Project No: 60452713
Report Sent To: John Drafts, Palmetto Environmental
Comments:
Client Name: Palmetto
Sample Received: 5/11/2024
Samples Received for analysis:
Lab ID Client Sample ID Received
60452713011 MW -22 5/11/2024 9:15:00
if you have any questions, please contact Heather Wilson at Pace.
Phone: 1(913)563-1407 Email: heather.wilson@pacelabs.com
A 2.5% CREDIT CARD SURCHARGE OF $45.38 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT Page 2 of 2
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
**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
Sold To:
Accounts Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LC1-1821617
Pace Analytical N1.7:, 820814289
Pace Analytical Services, LLC
9608 Loiret Blvd.
Lenexa, KS 66219
Phone: (913)599-5665
Date: 08/14/2024
Invoice #: 2460211693
Customer PO#:
14027
Terms:
Net 30
Due Date:
09/13/2024
Total Due:
$1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Client Number/Client iD
60-533532 i Palmetto
Purchase Order No
14027
Pace Project Mgr
Heather Wilson
Terms*"
Net 30
Page
Client Project: 1113 H St
Pace Project No: 60458225
Report Seat To: John Drafts, Palmetto Environmental
Comments:
Client Name: Palmetto
Sample Received: 8/8/2024
Quantity Unit Description
ANALYTICAL CHARGES
Method Matrix
Price Total
11 Ea 8015B TPH-DRO
11 Ea 8260 BTEX & GRO
EPA 80158 Water
Water
$90.00 $990.00
$75.00 $825.00
Analytical Subtotal $1,815.00
Samples Received for analysis:
Lab ID Client Sample ID
60458225001 MW-03RR
60458225002 MW -13
60458225003 MW -14
60458225004 MW -15
60458225005 MW -16
60458225006 MW -17
60458225007 MW -18
60458225008 MW -19
60458225009 MW -20
60458225010 MW -21
Total Number of Charges 22 Total Invoice Amount $1,815.00
Received
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
8/8/2024 8:30:00
If paying by credit card, a 2.5, surcharge of $45.38 will be assessed, PAY $1,860.38
A 2.5% CREDIT CARD SURCHARGE OF 545.38 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT Page 1 012
AND ACH/E-CHECKS INCUR NO ADDITIONAL FEES.
**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 return copy of invoice with your payment.
INVOICE TOTAL $1,815.00
Amount Paid: $
Check No:
Customer No: 60-533532 Invoice No: 2460211693
�ce
Sold To:
Accounts Payable
Palmetto Environmental
4995 York Street
Denver, CO 80216
303-825-8117 x107
INVOICE
Pace Analytical Services, LLC 411821617
Pace Analytical National 620814289
Pal nal�tical Services, LLC
9608 Loiret Blvd.
Lenexa, KS 66219
Phone: (913)599-5665
Date: 08/14/2024
Invoice #: 2460211693
Customer PO#: 14027
Terms: Net 30
Due Date: 09/13/2024
Total Due:1$1 $1,815.00
Please Remit To:
Pace Analytical Services, LLC
P.O. Box 684056
Chicago, IL 60695-4056
Client Number/Client ID
60-533532 / Palmetto
Purchase Order No
14C27
Pace Project Mgr
Heather Wilson
Terms""
Net 30
Page
Client Project: 1113 H St
Pace Project No: 60458225
Report Sent To: John Drafts, Palmetto Environmental
Comments:
Samples Received for analysis:
Lab ID Client Sample ID Received
60458225011 MW -22 8/8/2024 8:30:00
Client Name: Palmetto
Sample Received: 8/8/2024
If you have any questions, please contact Heather Wilson at Pace.
Phone: 1(913)563-1407 Email: heather.Wilson@pacelabs.com
A 2.5% CREDIT CARD SURCHARGE OF $45.38 MAY BE ADDED TO ANY CREDIT CARD PAYMENT. DEBIT
AND ACHIE-CHECKS INCUR NO ADDITIONAL FEES.
**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
Page 2 of 2
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
1 105 H Street
PO Box 758
Greeley CO 80632
United States
Shipping Date: 1/15/2025
INVOICE
PALMETTO
t,.i. �atJNMEN'in�
An Nwestco Company
Invoice # INV524928
Invoice Date 12/31/2024
Due Date 3/16/2025
Terms Net 75
PO#
Work Order#
Customer Weld County
Government
Amount Due $18,800.98
Item
Description
Qty
Rate
Amount
Tax
Environmental Billing
Fees
Environmental Billing Fees, See attached sheet
for detail.
$18,800.98
$18,800.98
2-6-24 to 8-8-24
Subtotal:
Discounts:
Sales Tax:
Payment:
$18,800.98
$0.00
($0.00)
Amount Due:
$18,800.98
Problem Notes
Solution Notes
Release: 12712
1 of 1
Palmetto Environmental RCR for Rol 12712 - 2.6-24 to 8.8-24 REP 8:
Client Name: Nbld County 0,4 of Public Works Erg.
Billing Atldree.- PO Baz 759
city, State,/ p: Greeley, CO 80632
Site Name: NbW Counh Fu.hno Fsdih
Site Address
Start Die:
26
2/6/2024 End Date:
8/8/2024
0
0
z
w
CONSULTANT SUBCONTRACTOR SdRd:4 RACTO %OW <
INVOICE a INVOICE e R NAME EMPLOYEE NAME Ns7RK
Johnny Kounkong 2162024 3G
Johnny Kounkong 2/72024 3G
a.
a
9K OR LABOR CODE (TLC)
TASK DESCRIPTION
5.6 Senior technician - Field pre.
5.6
colortpenre an -Surveying and
evelopment
? O J i
hour. 0.50 585.00 542.50
hour.
3.50 585.00 5297.50
$42.50
5297.50
Bryan MIA. 2/72024 3G
2/72024 3G
2/72024 3G
2/7/2024 3G
2/72024 3G
Ch. Bud 2/72024 36
Bryan Mills 2/92024 36
Ch. Bird 2/15/2024 30
Ch.. Chapman 2/152024 3G
9
S.
9
J.
B
5.8
12.1 Miscellaneous field suppfies
13.17 Survey equipment
13.19 TrOfic control
9.4 Mileage
Senior techmnan - Development
end survepng wdh JK, travel lime
5.3
5.8
5.a
5.5
11.99 Mandest and handling lee
11.5 Waste disposal
Protect Mashcnager - Rewew Eagle
Synergiinvoice
6tafl techn¢u
management
hour.
day 1.00 512.00 512.00
day 1.00 545.00 545.00
day 1.00 525.00 525.00
mile. 117.D0 50.67 $78.39
3.50 385.00 5297.50
hours
hours
hours
hour.
each 1.00 545.00 545.00
gallon. 47.50 SO 85 $40.38
0.25 5148.00 537.00
1.00 571.00 571.00
0.50 585.00 542.50
0.50 $8500 512.50
5297.50
812.00
545.00
525.00
578.39
537.00
571.00
542.50
542.50
545.00
540.38
12712-21524 Petro... 2/152024 30
12712-21524 PetToWa.te 2/152024 3G
Bryan MIN. 2/152024 3G
Ch. Chapman 2/152024 3G
12712-21524 PetroWaste 2/152024 30
Ch. Bid 2/152024 3G
2/182024 3G
Bryan Mills 2/182024 3G
Ch. Bid 2/182024 3G
9
9
9
9
9
9
q
5.3
Stan EngmeerMcienhst - Sample
5.5
5.6 Professional time
5.6 Semor Technician - Sample meat,
4.1 Sample Wells
5.3 Protect Manager-COC check
5.6
CSenior technician - travel, decor.
OC
Senior Mehnician -travel, tlewn.
COC
Senior technan - GW caobr Prep
entl ledez dmp on.
hour
hours
hour. 1.00 585.00 $85.00
0.50 5148.00 574.00
5108.00 554.00
hours
wells 11.00 5130.00 51.430.00
hour. 0.25 5148.00 537.00
0.50 585.00 542.50
hours
3.50 585.00 5297.50
574.00
$54.00
585.00
542.50
51 ,430.00
537.00
5297.50
Ch. Chapman 2/182024 3G
Chao Chapman 2116/20243G
2460201442 PACE 2/162024 3G
2460201442 PACE 2/16/2024 3G
2/182024 3G
Johnny Kaunkong 2232024 3G
John O.11. 2/23/2024 3G
➢
8
9
B
8
5.6
5.6
6.3 TEPH
6.7 BTEX/TVPH
5.6
5.2
Mileage
hours
ha-
...las 11.00 590.00 $990.00 5148.50
samples 11.00 575.00 5825.00 5123.75
miles 117.00 $0.67 578.39
hour. 1.25 585.00 5106.25
3.50 585.00 5297.50
0.75 $85.00 583.75
hours
0.75 5180.00 5120.00
5297.50_
563.75
$1,138.50
5948.75
578.39
5108.25
5120.00
Ch. Bed 2/182024 30
Bryan Mina 2282024 30
k.
5.8
5.8
nror technician - Waste mamfaet r tlrum pickup! tlmm managemen
6[afl technician - arum
management, tlewatenng
haunt
hours
0.25 585.00 521.25
1.50 571.00 5108.50
521.25
5106,50
0035366-1528.3
6035500-1528-7
WameMgmt
WaateMgmt
Bryan Mips
Chris Bird
Johnny Kounkong
Ch. Chapman
Chef Chapman
Ch. Chapman
2/29/2024
229/1024
4/42024
5/92024
592024
592624
519/2024
5/10/2024
5/10/2024
5/102024
5/10/2024
5/102024
5/10/2024
5/10/2024
5/102024
5/102024
5/102024
3G
3G
3G
3G
3G
36
3G
3G
k.
9-
9
y
9'
8
9'
5.8
11.99
5.3
5.6
5.6
5.5
4.1
5.6
5.6
11.99
11.5
5.8
6.3
6.7
Waate tlsposal
scan tecnnio
nagement
Waale pmfile
Project Manager - Sampling
meeting
rtnnule dmm
Senior techmcen - field prey
Sample Wells
Senior lechnican - GW samples
cooler prep
Senior technician - IRvel, demon,
COC
Manifest and handl, lee
West. deposal
Prolearonal Sine
TEPH
BTEX/TVPH
drums
houn
each
houn
houn
houn
houn
was
houn
hours
houn
each
gallons
hours
sample.
sample,
mdea
4.00
1.00
1.W
0.50
0.50
0.50
0.50
11.00
0.25
3.25
3.25
1.00
5114.58
571.00
535.00
5148.00
685.00
585.00
5108.00
5130.00
$85.00
$85.00
$85.00
$45.00
5458.32
571.00
$35.00
574.00
542.50
fA2.50
$54.00
51,430.00
$21.25
5276.25
5276.25
588.75
55.25
5527 07
571.00
510.25
574.00
342.50
$42.50
551.00
51,430.00
521.25
$276.25
5276.25
51024-12712
51024-12712
51024-12712
2460206275
2460206275
Petro Waste
PatroWaste
PetraWeste
PACE
PACE
Jahn Drag,
John Dr.
8124/2024
7/11/2024
7/112024
3G
3G
3G
3G
8'
8'
8'
A'
8'
8'
5.2
5.2
7.10
houn
hour.
report
13.50
too
11.00
11.00
117.00
1.00
1.50
1.00
50.85
585.00
590.00
57500
50.67
$150.00
$180.00
$45.00
511.48
585.00
5990.00
5825.00
578.39
6160.00
5240.00
5148.50
5123.75
545.00
511.48
585.00
51,138.50
$948.75
$78.39
5160.00
5240.00
Chris B.
13/52024
3G
5.3
REP Time - final MRR rewew
MRR - aeamennuel, no syatem
hour.
0.50
$2,981.00
$155.00
52,991.00
577.50
52,981.00
577.50
2480211893
2480211893
PACE
PACE
Johnny Kounkong
Johnny Kounkong
Chris Chapman
Johnny Kounkong
Chria Bird
Chris Bird
852024
6/5/2024
8/52024
13/6/2024
8/62024
815/2024
852024
8/62024
8/72024
0/1/2024
3G
3G
3G
3G
3G
3G
3G
3G
3G
3G
8
9'
9
9
8'
8'
9
58
5.6
5.5
4.1
5,6
6.3
6.7
9.4
5.5
5.3
Senior tedlmcian - field prey
Stan engieeerlacienhst - GW
sampling neepnp.
Sample Wepa
Saner technic. - travel, demon,
COC
TEPH
BTEX/TYPH
Mileage
Staff engineer/scentet - COC
review/ pack samples for ,hipping
Project Manager - Review Pace
SAF/COL
houn
hours
hours
wen.
hours
samplea
samples
miles
hours
houn
o.5a
1.00
0.50
11.00
3.25
11.00
11.00
117.00
0.50
0.25
589.00
589.00
5114.00
5132.00
589 00
$90 00
575.00
$0.67
$114130
5155.00
544.50
$89.00
$57.00
51 452.00
5289.25
5990.00
6825.00
$78.39
657.00
538.75
$148.50
5123.75
544.50
569.00
$57.00
51,452.00
5289.25
$1,138.50
5948.75
578.39
557.00
538.75
518,800.98
Contract Form
Entity Information
Entity Name" Entity ID*
PALMETTO ENVIRONMENTAL @00034965
GROUP LLC
Contract Name*
COLORADO PETROLEUM TANK STORAGE FUND
REIMBURSEMENT APPLICATION
Contract Status
CTB REVIEW
New Entity?
Contract ID
9115
Contract Lead *
CDOVIDIO
Contract Lead Email
cdovidio@weld.gov;cpatt
elli@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
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* Department
AGREEMENT ACCOUNTING
Amount*
$18,800.98
Renewable *
NO
Automatic Renewal
Grant
IGA
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* 02/13/2025
02/17/2025
Will a work 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 *
12/31/2024
Committed Delivery Date
Renewal Date
Expiration Date*
12/31/2024
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
02/18/2025 02/18/2025 02/18/2025
Final Approval
BOCC Approved Tyler Ref #
AG 022425
BOCC Signed Date Originator
RWILUAMS
BOCC Agenda Date
02/24/2025
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