Appendix D - Response Facility Information.docx
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Appendix D Contract Service Area: _____________
RESPONSE FACILITY INFORMATION
Contractor shall list all locations from which response personnel and/or response equipment will be stationed. (Use additional sheets as necessary.)
Contractor / Sub-contractor: (Circle One) Street:
City/State/ZIP:
EPA ID Number: _______________________________________ DOT Transporter Number: _______________________________________ GPS Coordinates: (If available) Longitude____________ Latitude____________
24/7 Emergency Telephone Number:
Number of response personnel and vehicle:
Personnel ( ) Vehicle(s) ( )
TRANSFER FACILITY/TRANSFER STATION INFORMATION
Contractor shall list all locations that will be used as transfer facilities/transfer stations, if not listed as a Response Facility. (Use additional sheets as necessary.)
Transporter 1: ___________________________________ Street:
City/State/ZIP: ___________________________________ EPA ID Number: ________________________________________ DOT Transporter Number: ________________________________________ GPS Coordinates: (If available) Longitude____________ Latitude_____________
Transporter 2: ___________________________________ Street:
City/State/ZIP: ___________________________________ EPA ID Number: ________________________________________ DOT Transporter Number: ________________________________________ GPS Coordinates: (If available) Longitude____________ Latitude_____________
EPA/STATE DISPOSAL FACILITY
Contractor shall list all disposal facilities where final disposal will occur. (Use additional sheets as necessary.)
Disposal Facility:
Street:
City/State/ZIP: _____________________________________ EPA ID Number: _______________________________________ Part B Permit Number: _______________________________________ GPS Coordinates:
Longitude_____________ Latitude___________
| Indicate applicable disposal method provided by the Disposal Facility |
| Final Disposal Method:_______________________ |
Final Disposal Method:_______________________
Disposal Facility:
Street:
City/State/ZIP: _____________________________________ EPA ID Number: _______________________________________ Part B Permit Number: _______________________________________ GPS Coordinates:
Longitude_____________ Latitude___________
| Indicate applicable disposal method provided by the Disposal Facility |
| Final Disposal Method:_____________________ |
Final Disposal Method:_______________________
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