Attachment 08 DLA Form 2505.pdf

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Line Item # Document # HIN # P/U Qty P/U

Mnfst # Mnfst Pg/Li Qty Disposed or

Received Interim/Disp Manifest #

Interim/ Disposal Facility EPA ID # Interim/ Disposal MMC

TSDF Accept Dates/ PCB Dates

(DD/MMM/YY)

Invoice Prescribe by: FAR 32.9/DLAM 4140.15 Sponsor: Disposition Services

COMPANY NAME: CONTRACT #: TO #: INVOICE AMOUNT ($): DATE:

"I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT THIS CONTRACT PERFORMANCE SUPPORTING DATA IS ACCURATE, COMPLETE AND MEETS ALL REQUIREMENTS SET FORTH IN

THE CONTRACT."

NAME: Signature:

2505 04/2021 (Draft Revision) 1

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Line Item # Document # HIN # P/U Qty P/U

Mnfst # Mnfst Pg/Li Qty Disposed or

Received Interim/Disp Manifest #

Interim/ Disposal Facility EPA ID # Interim/ Disposal MMC

TSDF Accept Dates/ PCB Dates

(DD/MMM/YY)

PDF (DLA)DLA Form 2505, FEB 2022 Page 1 of 2

2505 04/2021 (Draft Revision) 2

INSTRUCTIONS

NOTE 1: For special service and supply items, complete only blocks 1, 2, 3 and 7.

NOTE 2: For foreign contract disposal lines, complete all columns.

NOTE 3: For US contracts, complete all columns only when the task order contains line(s) requiring a Certification of Destruction (CD) or Certification of Recycling (CR) or contains HIN 650300. Complete only columns 1 thru 7 and 11 when the task order DOES NOT contain line(s) requiring a certificate of destruction (CD) or a certificate of recycling (CR) or HIN 650300.

Column 1: Line Item # - DD Form 1155 or SF30 line-item number for the supply or service ordered. (Four digits - e.g.: 0001)

Column 2: Document # - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., ABCD1234)

Column 3: Hazardous Item Number (HIN) # - HIN Number as it appears on DD Form 1155 or SF30 (Six characters -e.g.: NR04C7)

Column 4: Picked Up (P/U) QTY - Actual quantity picked up.

Column 5: P/U Mnfstr # - Manifest document number assigned to each manifest or shipping paper used to ship the waste to the initial TSDF (5 or 12 characters - e.g.: 02034; 123456789GBF)

Column 6: Manifest Page/Line- Identify the page and manifest line number that the document number has been placed on from manifest block 9a, 27a, etc…. (Does not apply for foreign contracts.)

Column 7: Final QTY Disposed or Received – Actual quantity of item disposed or service/supply performed/delivered.

Column 8: Interim/ Disposal Manifest # - Manifest document number assigned to each manifest or shipping paper used to ship all, or parts of the waste to other TSDFs, including all interims and finals, after receipt at initial TSDF. EXCEPTION: If final treatment/ disposal is accomplished by the initial TSDF, insert "Same as # 5 or SAC5" in column 8.

Column 9: Interim/Disposal Facility EPA# - EPA Identification number (or DLA Disposition Services "MOCK" number) assigned to each facility involved in the treatment, storage, and final disposal. (As defined in section 5.0 of the contract) of the item. Use additional lines as necessary. (Twelve digits - e.g.: PAD456123912) NOTE: If final disposal did not occur at the initial facility, then the initial facility is considered an interim facility for tracking purposes. In those instances, the initial facility's EPA ID number should be included in Column 9 when information is submitted.

Column 10: Final Disposal MMC Codes - List the appropriate Management method code(s) listed in the Hazardous Waste Report Instructions and Forms online (https://www.epa.gov/sites/production/files/2015-06/documents/codes.pdf). (40 CFR 264, Appendix 1, Table 2 no longer applies), performed by any final disposal facilities. Note: Include any treatment and/or handling performed at initial TSDF, which was NOT identified in initial facility.

Column 11: Interim/Disposal TSDF Accept Date and Disposal Date (and CD/CR required lines when applicable) - Actual date listed on the shipping paper next to the signature of the representative of each and every interim and final TSDF's accepting, treating, and/or disposing of the waste (dd/mmm/yy). NOTE - Date of actual final disposal of CD/CR required lines item (dd/mmm/yy).