Geologist Vendor File Resume KDHE - BER - Storage Tank Section · 2019-05-13 · Geologist Vendor...
Transcript of Geologist Vendor File Resume KDHE - BER - Storage Tank Section · 2019-05-13 · Geologist Vendor...
Geologist Vendor File Resume – Page 1 revised 5/1/19
Geologist Vendor File Resume
KDHE - BER - Storage Tank Section
Applicant:_______________________________________for: Field Geologist_____________ Project Geologist*_____________
Employers Name:_____________________________________Supervisors Name:_______________________________________
Office Location: ____________________________________________________________________________________________
Office Phone: _______________________ Fax: ________________________________ Cell: _____________________________
Email:____________________________________________________________________________________________________
Education: College and/or University(s) attended:____________________________________________________________________
Degree(s):__________________________________________________________________________________________
Semester Hrs. of Geologic Course Work:__________________________________________________________________
Required Documentation: College Transcript__________ (Requirement if not a licensed Geologist in Kansas)
O.S.H.A. (Hazmat) 40 hr. certificate__________ 8 hr. Refresher Certificate_________
Kansas Licensed Geologist Certificate_________ (Seal may be used - Requirement for Project Geologist)
RBCA Certification ______________ (Required for RBCA report preparation.)
Experience: Bore Holes (Minimum requirement for Field Geologist & Project Geologist: Has overseen drilling activities and has described and
recorded the subsurface lithology during the drilling of at least 21 boreholes.)
Site Name: Location: No. of Boreholes: Reference & Phone #’s:
_________________________ ___________________________ _________ _____________________________
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Soil Vapor Extraction/Air Sparge Tests - Required for SSA/RDP, RDP, ReDI SRP, SRP & OMM work. (Minimum requirement for
Project Geologist: Has been trained and performed a minimum of 2 successful pilot tests of the remedial technology listed in the
Exhibit 2 Project Bid Proposal Sheets.) Field Geologist may complete if meets the minimum requirement.
Site Name: Location: Type of Test & Duration: Reference & Phone #’s:
_________________________ ___________________________ ____________ __________________________
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Geologist Vendor File Resume – Page 2 revised 5/1/19
Certification by the proposed Field Geologist’s supervisor: (Supervisor must be a licensed geologist in Kansas and their seal must be affixed to this document.)
I hereby certify that the above information is correct and that the proposed Field Geologist meets the minimum
criteria as specified in SECTION 1.0 of the RFPs.
Supervisors Name:_______________________________________ Title:_________________________
(Print or type name) (Print or type title)
Signature:_____________________________________________ Date:__________________________
Certification by the proposed Project Geologist: I hereby certify that the above information is correct and that I meet the minimum criteria as specified in SECTION 1.0 of the RFPs.
Signature:_____________________________________________ Date:_______________________________
Submit completed form to [email protected] or Attn: Contractual Services Unit to KDHE, 1000 SW Jackson, Suite 410, Topeka, KS 66612-1367. *If a resume for Field Geologist was previously submitted, complete Project Geologist qualifications and provide required documentation and any updates.
affix seal here