Attachment 10_DLA 2514_Contract Modification Request.pdf
PDF 38 KB Posted
- Attached to
- United Kingdom Hazardous Waste Disposal
- Solicitation number
- SP450026R0007
- Issued by
-
Defense Logistics Agency
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PAGE OF PDF (DLA)
DLA FORM 2514, MAY 2025
D L A FORM 0 0 1 3, AUGUST 20 22
Prescribed by: SOP 4140.12-001 Sponsor: Disposition Services
HAZARDOUS WASTE CONTRACT MODIFICATION REQUEST
DLA DRAFT NOT FOR PRODUCTION
PAGE OF PDF (DLA)
DLA FORM 2514, MAY 2025
D L A FORM 0 0 1 3, AUGUST 20 22
Prescribed by: SOP 4140.12-001 Sponsor: Disposition Services
HAZARDOUS WASTE CONTRACT MODIFICATION REQUEST
DLA DRAFT NOT FOR PRODUCTION
SECTION 1 - COR / CONTRACT INFORMATION
SECTION 2 - ADDING PROFILE BASED DISPOSAL
CLIN 1
5. APPLICABLE WASTE CODES
A. CHARACTERISTIC
B. LISTED
C. STATE/HOST NATION
D. ANALYTICAL/SDS ATTACHED?
6. PHYSICAL STATE
7. REQUESTED BASE CLIN AND SUFFIXES
A. BASE
B. SUFFIX
Enter a Suffix. Block B.1.
Enter a Suffix. Block B.1.
Enter a Suffix. Block B.1.
Enter a Suffix. Block B.1.
Enter a Suffix. Block B.1.
8. ENTER ESTIMATED ANNUAL GENERATION QUANTITY
CONTAINERIZED WASTE (EA)
(C1) (C2) (C3) (C4) (C5) (C6) (T1) (T2) (T3)
BULK SOLIDS (POUNDS) (MINIMUM MAY APPLY)
BULK PUMPABLE LIQUIDS (GALLONS)
LIGHTWEIGHT BULK (CUBIC YARDS)
BULK PUMPABLE LIQUIDS (LITERS)
BULK HEAVY SOLIDS (KILOGRAMS)
MISCELLANEOUS UNITS (COMPRESSED GAS CYLINDERS, HYBRID SCHEDULES, STINGING CONTAINERS)
9. IS THIS A ONE-TIME USE CLIN?
10. OPTION PERIOD
11. FREQUENCY OF REMOVALS
12. LOCATION OF THE WASTE IF DIFFERENT FROM GENERATOR INFORMATION
13. NUMBER OF CONTAINERS, POUNDS, KILOGRAMS, LITERS, GALLONS, OR MISCELLANEOUS UNITS READY FOR DISPOSAL AT TIME OF REQUEST
14. TOTES / IBC CONTAINER SIZE, REMOVAL / DISPOSAL METHOD
(T1) (T2) (T3) NOTE: ATTACH SUPPORTING DOCUMENTS WITH THIS REQUEST, (SDS, ANALYTICAL RESULTS, UP TO DATE HWPS, USER KNOWLEDGE NARRATIVE, ETC.)
SECTION 3 - GENERATOR INFORMATION
SEND THE COMPLETED MOD REQUEST FORM TO HWCONTRACTREQUIREMENTS@DLA.MIL AND ALLOW UP TO THREE BUSINESS DAYS FOR A RESPONSE.
9.0.0.2.20100902.2.720808 DLA 2514 - Hazardous Waste Contract Modification Request DLA 2514 - Hazardous Waste Contract Modification Request 07/24/2024 09/2024
CLIN 1
| Current Page Number: |
| Total Number of Pages: |
| Click this button to Print this form.: |
| Click this button to Email form.: |
| Click this button to Clear the form: |
| C O R / Contract Information. Enter the Date. Date format: 2 digit month. / 2 digit day. / 4 digit year. Example: 01/01/2024 Block 1. : |
| Enter the C O R Requesting Mod Phone Number. Enter digits only. Include area code. Block 6.: |
| Click this button to delete the current CLIN.: |
| Location of Waste. Enter the Building Number. Block 12. A.: |
| Enter T 3. (Up to 330 G L per 1250 Liters. Block 14. : |
| Enter the Applicable Waste Codes. Check this box for Analytical or SDS are not Attached. Block 5. D.: 0 |
| Physical State. Check this box for: Multi-Phase. Block 6.: 0 |
| Miscellaneous Units (Compressed Gas Cylinders). Check this box for M 3. Block 8.: 0 |
| Is this a one-time use CLIN? Check this box for No. Block 9.: 0 |
| Option Period. Check this box for both Base and Option. Block 10.: 0 |
| Check this box for Other. If selected enter an other frequency of removal value. Block 11.: 0 |
| Enter an other frequency of removal value. Block 11.: |
| Number of Containers, Pounds, Kilograms, Liters, Gallons, or Miscellaneous units ready for Disposal at time of request. Enter M 2. Block 13. J.: |
| Totes / I B C Container size, Removal / Disposal Method. Check this box for: Off-Site Removal and Disposal of Tote. Block 14.: 0 |
| btnAdd: |
| Enter the Installation Address. Block 18.: |
| Enter the E P A. I D. Number. Block 16.: |
| Enter the Bill to D o D A A C. Block 17.: |
| Enter the Generator POC Full Name. Block 19.: |
| Enter the Generator POC Phone Number. Enter digits only. Include area code. Block 20.: |
| Enter the Generator Point of Contact. Block 21.: |
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