Attachment 04 - Qualified Facility List Update - DLA Form 2507-2.pdf

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

PDF (DLA)

DLA FORM 2507-2, OCT 2016 PREVIOUS EDITION IS OBSOLETE

QUALIFIED FACILITY LIST UPDATE

Prescribed by: DLAI 4160.14 Sponsor: Disposition Services Page of Instructions

For changes since your last update, provide all applicable information and documents with this completed checklist. Record Yes, N/A, or No Change in update column as it applies to the facility. Failure to provide all required information constitutes grounds for removal from the QFL as stipulated by "the use of Facilities and Transporters" section of DLA Disposition Services Hazardous Waste Contracts.

Requirement

REGULATORY AND FINANCIAL ASSURANCE

Submitted Applicant Comments

1. According to the U.S. EPA Civil Enforcement Response Policy, have any RCRA Class One/ Two or other Significant Noncompliance (SNC) violations been issued to the facility? If yes, provide regulatory NOV documentation. (US Facilities Only)

2. Any administrative or judicial consent orders, corrective actions, or supplemental environmental projects in the last 3 years? If yes, provide documentation.

3. In the last 12 months has your facility caused a government generator to have to file a manifest exception report in accordance with 40 CFR 262.42(a)(2), or a state equivalent? (US Facilities Only)

4. Facility closure amount and financial mechanism (e.g., bond, trust, letter of credit). If closure instrument is not required by regulation, facility must satisfy item #5. Provide copy of actual financial instrument submitted to regulatory office.

5. Current certificates of accord showing pollution liability limits and other insurance coverage. If pollution liability insurance is not in place, facility must satisfy item #4. (Exception applies to non-hazardous facilities only).

6. Facility permit(s) cover page(s) recording expiration date.

7. Have any delays in returning signed manifests to the generator triggered exception reporting in the last year? (US Facilities Only)

8. Latest third party compliance inspection/report (Fed, State, Local, DLA) and documentation of corrective actions, no older than 18 months. See instructions.

9. Current facility environmental POC with phone number and e-mail address

10. Current environmental regulatory agency POC with phone number and e-mail address.

Clause For DLA Use Only – Verifications and QFL Recommendation Verifier Comments Results Has the Contractor submitted all required documentation and information?

ECHO report reviewed?

If Contractor exhibited a history of noncompliance, was evidence of corrective action provided?

If Contractor received a negative recommendation from a Disposition Service inspection was evidence of corrective action provided?

After conducting the review and verifying documents, I recommend the following:

Recommendation As the Verifier, I certify that the information provided on this form is true and correct.

9.0.0.2.20100902.2.720808 http://www.dla.mil/officialforms/files1/dl2507-2.pdf none

DL2507-2

Disposition Qualified Facility List Update Mar 2015

Telephone: +XXX-XXX-XXXX Email: XXXX@XXX.XXX applComments: Regulatory Agency POC: XXXXXXXXX Telephone: +XXX-XXX-XXXX Email: XXXX@XXX.XXX