Appendix C - Receipt of Service.docx

Appendix C

RECEIPT FOR SERVICES

The following information must be completed for each Generating Facility and verified by the on-site representative at the site prior to the Contractor’s departure.

Task Order number:___________________ DEA Control/Call number:_________________ Case “S” Number: ____________________

Date/Time of Initial Call: / / ________ AM/PM Site ____ of _____ Agreed Upon Date/Time of Arrival:_____/____/____ ________ AM/PM (if multiple Locations)

Site Address:

Latitude (y): ________________________ Longitude (x):____________________________ Delays, if any, were caused by: ________________________________________________________________________

Name of each contract employee responding to the Generating Facility:

Time Crew Arrived on Site: _______________ AM/PM Time Crew Departed Site:____________AM/PM

Manifest / Shipping Document Control Number(s): ____________________________________

Total number of containers removed from the Generating Facility: ________________________ [This MUST agree with the quantity of containers identified on the manifest(s) and/or DOT Shipping Document(s).]

DEA/FBI REPRESENTATIVE VERIFICATION

On behalf of (Agency Name) _________________________________________________, I have verified the following:

Identification:

All contractors presented valid photo identification upon arrival at the generating facility. All drivers hauling hazardous waste must have a valid CDL with HazMat endorsement.

Containers:

Verified the total number of containers removed from the generating facility.

Adulteration:

All mixtures and/or waste suspected of containing listed or controlled substances were adulterated prior to removal from the generating facility.

I have reviewed and confirmed all information contained on this form and acknowledge receipt of the services provided by the contractor. I rate the contractor’s performance as ___outstanding ___acceptable __unacceptable.

Printed Name of DEA/FBI Representative Signature Date

Form DEA-602 Receipt for Service (2019)