Attachment 13 - well_decom_form-fillable.pdf

PDF 135 KB Posted

Attached to
Demo Dental Clinic Federal contract opportunity
Solicitation number
FA301020R0006
Issued by
Department of the Air Force Air Education and Training Command

About this file

Written by GovTribe AI ·

This document contains a federal contract solicitation for demolition services. Keesler Air Force Base requires demolition and removal of an existing dental clinic building, equipment shed, and associated site features. The work includes furnishing all labor, materials and equipment to demolish the structures and restore the site to a natural condition. The North American Industry Classification System code for this opportunity is 238910 for site preparation contractors. The acquisition will be conducted as a set-aside for Service-Disabled Veteran-Owned Small Businesses. The period of performance is 160 days from notice to proceed with a proposed construction value between $250,000 and $500,000. Interested SDVOSB contractors should monitor the FedBizOpps website for posting of the solicitation package on or around November 27, 2019, with a closing date of December 31, 2019. Registration in the System for Award Management is required for consideration. The contracting office points of contact are provided for any questions regarding this demolition services requirement at Keesler Air Force Base.

View the file

Other files for this federal contract opportunity

Other files attached to Demo Dental Clinic, newest first.
File Type Posted
Attachment 14 - Addendum 1.pdf PDF
Solicitation Amendment FA301020R00060003 SF 30.pdf PDF
Attachment 12 - SDS index.pdf PDF
Solicitation Amendment FA301020R00060002 SF 30.pdf PDF
Attachment 11 - Power Plan.pdf PDF
Solicitation Amendment FA301020R00060001 SF 30.pdf PDF
Site Visit Sign In..pdf PDF
Attachment 4 - Wage Det MS2018141.pdf PDF
Attachment 6 - Past Performance Questionnaire.pdf PDF
Attachment 3 - MAHG181093 Demo Dental Clinic DWG.pdf PDF
Attachment 8 - MAHG181093 Hazardous Materials Survey.pdf PDF
Attachment 7 - Past Performance Reference List.pdf PDF
Attachment 1 - MAHG181093 Demo Dental Clinic SOW.pdf PDF
Solicitation - FA301020R0006.pdf PDF
Attachment 5 - AF 66.xlsx XLSX spreadsheet
Attachment 10 - Notice of Compliance.pdf PDF
Attachment 2 - MAGH181093 Demo Dental Clinic SPECS.pdf PDF
Attachment 9 - SF 1444.pdf PDF
Show all 18

On GovTribe

Work with this file on GovTribe

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY

Office of Land and Water Resources

P. O. Box 2309 Jackson, MS 39225

Water Well Plugging/Decommissioning Form

OLWR-DF-1 (04/08)

(601)961-5555 (601)961-5228 (fax)

COUNTY WELL LOCATED: WELL NUMBER:

PERMIT NUMBER: DATE WELL PLUGGED:

NAME OF FIRM TELEPHONE NUMBER:

PLUGGING WELL:

NAME AND ADDRESS OF

CURRENT LANDOWNER:

WELL LOCATION: SECTION: TOWNSHIP: RANGE:

WELL LOCATION: LATITUDE: LONGITUDE: METHOD (Check ONE): (1) USGS QUAD (2) CONVENTIONAL SURVEY

(3) GPS – HAND HELD OR SURVEY GRADE

DISTANCE: DIRECTION: NEAREST TOWN: OTHER LANDMARK:

WELL PURPOSE (HOME,

IRRIGATION, MUNICIPAL, ETC.):

NAME OF WELL CONTRACTOR

WHO DRILLED THE WELL:

NAME OF LANDOWNER WHEN

WELL WAS DRILLED:

WELL DATA

WELL DEPTH: HOLE DEPTH:

CASING DIAMETER (IN.): CASING LENGTH (FT.): TYPE OF CASING:

DEPTH TO STATIC WATER LEVEL: DATE WELL COMPLETED:

WHY IS THE WELL BEING ABANDONED?

DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED (AMOUNT OF CASING AND/OR SCREEN THAT WAS REMOVED OR LEFT IN HOLE, MATERIAL AND AMOUNT USED IN PLUGGING, METHOD OF PLACING MATERIAL, ETC.)

I CERTIFY THAT THE WELL WAS PLUGGED OR ABANDONED IN ACCORDANCE WITH THE STATE OF MISSISSIPPI REGULATIONS.

PRINT NAME MS LICENSE NUMBER

SIGNATURE DATE

COUNTY WELL LOCATED:
WELL NUMBER:
PERMIT NUMBER:
DATE WELL PLUGGED:
NAME OF FIRM TELEPHONE NUMBER PLUGGING WELL:
NAME AND ADDRESS OF CURRENT LANDOWNER:
WELL LOCATION SECTION TOWNSHIP RANGE:
WELL PURPOSE HOME IRRIGATION MUNICIPAL ETC:
NAME OF WELL CONTRACTOR WHO DRILLED THE WELL:
NAME OF LANDOWNER WHEN WELL WAS DRILLED:
WELL DEPTH:
HOLE DEPTH:
CASING DIAMETER IN:
CASING LENGTH FT:
TYPE OF CASING:
DEPTH TO STATIC WATER LEVEL:
DATE WELL COMPLETED:
WHY IS THE WELL BEING ABANDONED:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow1:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow2:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow3:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow4:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow5:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow6:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow7:
DESCRIBE HOW THE WELL OR HOLE WAS PLUGGED AMOUNT OF CASING ANDOR SCREEN THAT WAS REMOVED OR LEFT IN HOLE MATERIAL AND AMOUNT USED IN PLUGGING METHOD OF PLACING MATERIAL ETCRow8:
undefined_2:
PRINT NAME:
MS LICENSE NUMBER:
Text1:
Text2:
Text3:
Text4:
Text5:
Check Box6: Off
Check Box7: Off
Check Box8: Off
Text6:
Text7:
Text8:
Text9:
Text10:

File details come from the government source that posted it. Updated .