Attachment 6_DLA Form 2505 Invoice.pdf

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DLA FORM 2505, NOV 2023

PDF (DLA)

INVOICE

Prescribed by: FAR 32.9/DLAM 4140.15 Sponsor: Disposition Services

PAGE OF

PREVIOUS VERSIONS OBSOLETE

DLA NOT FOR PRODUCTION

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 1.

2.

4.

3.

6.

8.

7.

9.

10.

11.

LINE

ITEM #

DOCUMENT #

P/U QTY

HIN #

MNFST PG/LI

INTERIM/DISP

MANIFEST #

QTY DISPOSED OR RECEIVED

INTERIM/DISPOSAL

FACILITY EPA ID #

INTERIM/DISPOSAL

MMC

TSDF ACCEPT

DATES/CD

DATES

(DD/MMM/YY)

5.

P/U MNFST #

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 CD or 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/SF30" (Six characters -e.g.: NR04C7) Column 4: Picked Up (P/U) QTY - Actual quantity picked up.

Column 5: P/U Mnfst # - 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 Line item 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/MMMM/YY).

9.0.0.2.20100902.2.720808 Row 1. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 1. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 1. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 1. Enter the Picked Up (P / U) Quantity.

Row 1. Enter the P / U Manifest Number.

Row 1. Enter the Manifest Page / Line.

Row 1. Enter the Final Quantity Disposed or Received.

Row 1. Enter the Interim / Disposal Manifest Number.

Row 1. Enter the Interim / Disposal Facility E P A Number Row 1. Enter the Final Disposal M M C Codes Row 1. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 2. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 2. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 2. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 2. Enter the Picked Up (P / U) Quantity.

Row 2. Enter the P / U Manifest Number.

Row 2. Enter the Manifest Page / Line.

Row 2. Enter the Final Quantity Disposed or Received.

Row 2. Enter the Interim / Disposal Manifest Number.

Row 2. Enter the Interim / Disposal Facility E P A Number Row 2. Enter the Final Disposal M M C Codes Row 2. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 3. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 3. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 3. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 3. Enter the Picked Up (P / U) Quantity.

Row 3. Enter the P / U Manifest Number.

Row 3. Enter the Manifest Page / Line.

Row 3. Enter the Final Quantity Disposed or Received.

Row 3. Enter the Interim / Disposal Manifest Number.

Row 3. Enter the Interim / Disposal Facility E P A Number Row 3. Enter the Final Disposal M M C Codes Row 3. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 4. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 4. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 4. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 4. Enter the Picked Up (P / U) Quantity.

Row 4. Enter the P / U Manifest Number.

Row 4. Enter the Manifest Page / Line.

Row 4. Enter the Final Quantity Disposed or Received.

Row 4. Enter the Interim / Disposal Manifest Number.

Row 4. Enter the Interim / Disposal Facility E P A Number Row 4. Enter the Final Disposal M M C Codes Row 4. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 5. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 5. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 5. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 5. Enter the Picked Up (P / U) Quantity.

Row 5. Enter the P / U Manifest Number.

Row 5. Enter the Manifest Page / Line.

Row 5. Enter the Final Quantity Disposed or Received.

Row 5. Enter the Interim / Disposal Manifest Number.

Row 5. Enter the Interim / Disposal Facility E P A Number Row 5. Enter the Final Disposal M M C Codes Row 5. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 6. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 6. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 6. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 6. Enter the Picked Up (P / U) Quantity.

Row 6. Enter the P / U Manifest Number.

Row 6. Enter the Manifest Page / Line.

Row 6. Enter the Final Quantity Disposed or Received.

Row 6. Enter the Interim / Disposal Manifest Number.

Row 6. Enter the Interim / Disposal Facility E P A Number Row 6. Enter the Final Disposal M M C Codes Row 6. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 7. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 7. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 7. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 7. Enter the Picked Up (P / U) Quantity.

Row 7. Enter the P / U Manifest Number.

Row 7. Enter the Manifest Page / Line.

Row 7. Enter the Final Quantity Disposed or Received.

Row 7. Enter the Interim / Disposal Manifest Number.

Row 7. Enter the Interim / Disposal Facility E P A Number Row 7. Enter the Final Disposal M M C Codes Row 7. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 8. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 8. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 8. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 8. Enter the Picked Up (P / U) Quantity.

Row 8. Enter the P / U Manifest Number.

Row 8. Enter the Manifest Page / Line.

Row 8. Enter the Final Quantity Disposed or Received.

Row 8. Enter the Interim / Disposal Manifest Number.

Row 8. Enter the Interim / Disposal Facility E P A Number Row 8. Enter the Final Disposal M M C Codes Row 8. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 9. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 9. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 9. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 9. Enter the Picked Up (P / U) Quantity.

Row 9. Enter the P / U Manifest Number.

Row 9. Enter the Manifest Page / Line.

Row 9. Enter the Final Quantity Disposed or Received.

Row 9. Enter the Interim / Disposal Manifest Number.

Row 9. Enter the Interim / Disposal Facility E P A Number Row 9. Enter the Final Disposal M M C Codes Row 9. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 10. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 10. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 10. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 10. Enter the Picked Up (P / U) Quantity.

Row 10. Enter the P / U Manifest Number.

Row 10. Enter the Manifest Page / Line.

Row 10. Enter the Final Quantity Disposed or Received.

Row 10. Enter the Interim / Disposal Manifest Number.

Row 10. Enter the Interim / Disposal Facility E P A Number Row 10. Enter the Final Disposal M M C Codes Row 10. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 11. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 11. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 11. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 11. Enter the Picked Up (P / U) Quantity.

Row 11. Enter the P / U Manifest Number.

Row 11. Enter the Manifest Page / Line.

Row 11. Enter the Final Quantity Disposed or Received.

Row 11. Enter the Interim / Disposal Manifest Number.

Row 11. Enter the Interim / Disposal Facility E P A Number Row 11. Enter the Final Disposal M M C Codes Row 11. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 12. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 12. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 12. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 12. Enter the Picked Up (P / U) Quantity.

Row 12. Enter the P / U Manifest Number.

Row 12. Enter the Manifest Page / Line.

Row 12. Enter the Final Quantity Disposed or Received.

Row 12. Enter the Interim / Disposal Manifest Number.

Row 12. Enter the Interim / Disposal Facility E P A Number Row 12. Enter the Final Disposal M M C Codes Row 12. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 13. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 13. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 13. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 13. Enter the Picked Up (P / U) Quantity.

Row 13. Enter the P / U Manifest Number.

Row 13. Enter the Manifest Page / Line.

Row 13. Enter the Final Quantity Disposed or Received.

Row 13. Enter the Interim / Disposal Manifest Number.

Row 13. Enter the Interim / Disposal Facility E P A Number Row 13. Enter the Final Disposal M M C Codes Row 13. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 14. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 14. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 14. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 14. Enter the Picked Up (P / U) Quantity.

Row 14. Enter the P / U Manifest Number.

Row 14. Enter the Manifest Page / Line.

Row 14. Enter the Final Quantity Disposed or Received.

Row 14. Enter the Interim / Disposal Manifest Number.

Row 14. Enter the Interim / Disposal Facility E P A Number Row 14. Enter the Final Disposal M M C Codes Row 14. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 15. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 15. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 15. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 15. Enter the Picked Up (P / U) Quantity.

Row 15. Enter the P / U Manifest Number.

Row 15. Enter the Manifest Page / Line.

Row 15. Enter the Final Quantity Disposed or Received.

Row 15. Enter the Interim / Disposal Manifest Number.

Row 15. Enter the Interim / Disposal Facility E P A Number Row 15. Enter the Final Disposal M M C Codes Row 15. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023 Row 16. Enter Line Item Number - (Four digits - e.g.: 0 0 0 1) Row 16. Enter the Document Number - Document number as it appears on DD Form 1155 or SF30 (External PR) (Eight digits - e.g., A B C D 1 2 3 4) Row 16. Enter H I N Number - H I N number as it appears on D D Form 11 55 (Six characters - e.g.: 9 4 0 4 N C) Row 16. Enter the Picked Up (P / U) Quantity.

Row 16. Enter the P / U Manifest Number.

Row 16. Enter the Manifest Page / Line.

Row 16. Enter the Final Quantity Disposed or Received.

Row 16. Enter the Interim / Disposal Manifest Number.

Row 16. Enter the Interim / Disposal Facility E P A Number Row 16. Enter the Final Disposal M M C Codes Row 16. Enter the Interim / Disposal T S D F Accept Date and Disposal Date. Enter each date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023