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:

_________________________ ___________________________ _________ _____________________________

_________________________ ___________________________ _________ _____________________________

_________________________ ___________________________ _________ _____________________________

_________________________ ___________________________ _________ _____________________________

_________________________ ___________________________ _________ _____________________________

_________________________ ___________________________ _________ _____________________________

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:

_________________________ ___________________________ ____________ __________________________

_________________________ ___________________________ ____________ __________________________

_________________________ ___________________________ ____________ __________________________

_________________________ ___________________________ ____________ __________________________

_________________________ ___________________________ ____________ __________________________

_________________________ ___________________________ ____________ __________________________

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 kdhe.stscsu@ks.gov 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