2009 Cost Schedule - July 1, 2009

NOTE: The July 1, 2009 Schedule of Corrective Action Costs (Cost Schedule) applies to all State Assurance Fund reimbursement applications received on and after July 1, 2009.

In accordance with A.A.C. R18-12-601(D), Preapproval applications will not be accepted after 5:00 p.m. June 30, 2009. Direct Payment requests submitted against an ADEQ-approved Preapproval application received prior to July 1, 2009 must use the same Cost Schedule and Activity or Phase Codes that were approved in the Preapproval application.

• July 2009 Cost Schedule Introduction
• July 2009 Cost Schedule General Notes
• July 2009 Table of Cost Schedule Item Codes
• July 2009 Table of Cost Schedule Item Code Descriptions
• July 2009 Table of Phase Codes
• July 2009 Cost Schedule Statute and Rule References for Phases of Corrective Actions

2006 SAF Claim Forms (Updated June 4, 2006)

• Reimbursement Application
  • Reimbursement Application Form (PDF) (Word)
  • Primary Provider Invoice Checklist (PDF) (Word)
  • Reimbursement Worksheet (PDF) (Excel)
  • Reimbursement Worksheet Instructions
  • Summary of Work Form (PDF) (Word)
  • Affidavit: Proof of Payment (PDF) (Word)
• Direct Payment Request
  • Direct Payment Request Form (PDF) (Word)
  • Primary Provider Invoice Checklist (PDF) (Word)
  • Direct Payment Worksheet (PDF) (Excel)
  • Direct Payment Worksheet Instructions
  • Summary of Work Form (PDF) (Word)
  • Supplemental Cost Worksheet: Evaluation under A.R.S. § 49-1054(C)(2) (PDF) (Excel)
  • Instructions for Supplemental Cost Worksheet
  • Substitution Request and Waiver Table (PDF) (Excel)
  • Affidavit: Proof of Payment (PDF) (Word)
• Preapproval Application
  • Preapproval Application Form (PDF) (Word)
  • Preapproval Worksheet (PDF) (Excel)
  • Preapproval Worksheet Instructions
• General Use SAF Forms
  • 2006 Affidavit: Proof of Payment (PDF) (Word)
  • 2006 Notice of Withdrawal (PDF) (Word)

Previous Cost Schedule

• 1996 - 2008

Please return all completed forms (original signatures and dates are mandatory) to:

Arizona Department of Environmental Quality
Waste Programs Division
State Assurance Fund (SAF) Program
1110 West Washington Street
Phoenix, Arizona 85007