Attachment 7_DLA Form 2507 Apply for QFL.pdf
PDF 2 MB Posted
- Attached to
- Turkey Electronic Hazardous Waste Federal contract opportunity
- Solicitation number
- SP4500-26-R-0006
- Issued by
- Defense Logistics Agency
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PDF (DLA)
DLA FORM 2507, NOV 2023
APPLICATION FOR QUALIFIED FACILITY LIST (QFL)
OMB Control Number:0704-AQFL Expiration: 02/28/2026
REPLACES DLA FORMS 2507-1 & 2507-2, WHICH ARE OBSOLETE
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-AQFL, is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
SECTION 1
7. IS THE COMPANY/FACILITY DOING BUSINESS AS (DBA), USING A DIFFERENT NAME, OR FACILITY NAME HAS CHANGED WITHIN THE PAST THREE YEARS? IF YES, PROVIDE NAME(S).
8. IS THIS A NEW APPLICATION OR AN UPDATE TO A FACILITY CURRENTLY ON THE QUALIFIED FACILITY LIST?
SECTION 2
9. CONUS: IS THE FACILITY A RCRA PERMITTED TSDF AUTHORIZED TO RECEIVE MANIFESTED WASTE CODES?
10. OCONUS: IS THE FACILITY PERMITTED TO PERFORM ULTIMATE DISPOSAL OF HAZARDOUS WASTE?
11. PERMITTED PROCESS - COMPLETE ALL THAT APPLY WHETHER A NEW FACILITY OR UPDATE
PROCESS DESCRIPTION
PERFORMED ON-SITE
PROCESS DESCRIPTION
PERFORMED ON-SITE
PROCESS DESCRIPTION
PERFORMED ON-SITE
BATTERY DEMANUFACTURING
LAB PACKING
STABILIZATION
BULKING/CONSOLIDATION
MACRO ENCAPSULATION
STORAGE
CARBON ADSORPTION
MICRO ENCAPSULATION
SUBTITLE C LANDFILL
CHEMICAL DEACTIVATION
NEUTRALIZATION
SUBTITLE D LANDFILL
CHEMICAL PRECIPITATION (WWT)
PAINT RECYCLING/RE-USE
TRANSFER FACILITY
CHEMICAL TRANSFORMATION
PHASE SEPARATION/FILTRATION
THERMAL DESORPTION
DECHLORINATION
RECYCLING FACILITY
WASTE FUELS KILN
DEEP WELL INJECTION
RETORT
WASTE TO ENERGY
ELECTRONICS DEMANUFACTURING
SHREDDING/SEPARATION
OTHER
FUELS BLENDING
SMELTING
GAS RECOVERY
SOLIDIFICATION
RCRA INCINERATION
SOLVENT RECOVERY/REACTIVATION
SECTION 3
13. REGULATORY AND FINANCIAL ASSURANCE
REQUIREMENT
SUBMITTED
APPLICANT COMMENTS
A. According to the U.S. EPA or State Regulators, have any Significant Noncompliance (SNC) violations or High Priority Violations (HPVs) been issued to the facility within the last three years? If yes, provide corrective action and administrative or consent order.
B. Does the facility require General and/or Pollution Insurance to operate? If Yes, provide ACORD with expiration date. If No, provide explanation.
C. Is the facility required to have closure and post closure financial assurance? If no, please explain. If yes, please provide financial assurance mechanism submitted to regulatory authorities. It must be from the financial institution providing coverage.
D. Facility permit(s) cover page(s) recording expiration date. If facility permit is extended or under review for renewal, provide supporting documentation.
E. Latest third party compliance inspection/report (Fed, State, Local, DLA, Fire Dept.) and documentation of corrective actions. See instructions.
F. Current facility environmental POC with phone number and e-mail address.
G. Current environmental regulatory agency POC with phone number and e-mail address.
This application is for entities seeking to be placed on the DLA Disposition Services Qualified Facilities List (QFL) and is designed to be completed and submitted electronically. Provide all applicable information and supporting documents with this completed application. Make proper selections for the subject facility. Only companies currently under contract or that are bidding on a solicitation with DLA Disposition Services may request consideration for placement on the QFL.
Approval will not be granted until all required documentation and regulatory compliance status have been received and verified. Some requested information is applicable only to facilities in the USA.
Section One – Administrative Information. Complete blocks 1-8 in this section.
Official Facility Name. Provide name of facility as it is assigned on any regulatory permits. Designate if using a dba.
Facility I.D. Number. Provide assigned US EPA I.D. number if the facility is in the USA. If the facility does not have a US EPA I.D. or an assigned facility I.D. number from DLA, leave blank.
DLA Prime Contractor Name. Provide the current DLA prime contractor's company name.
Contract Number. Provide the contract number that the DLA prime contractor is working under for waste that would be shipped to the facility.
Doing Business As (dba) or Name Change. List registered business name or previous facility name(s) within the last three years.
Section Two – Permitted Process. Check all processes that are used to treat, store, recycle, or dispose of material regardless if permits are required to be in place.
Section Three – Regulatory and Financial. Many of the requirements in this section are designed for facilities located in the USA and its Territories, Canada, and Mexico. If the facility is located outside the United States and the question does not apply, annotate in the ‘Applicant Comments” section.
Do not leave a requirement unanswered and where requested, supporting documentation must be provided. Not providing requested information and/or supporting documentation will slow the review process. Regular regulatory compliance auditing is defined as any multi-media audit by a third party or an inspection by environmental regulatory enforcement official. The report should be no older than 18 months.
Application Submitter. Print name and phone number of prime contractor representative completing the application. Application will not be accepted without this information. Once form is complete, submit to DLA Disposition Services at TSDFANDTRANSPORTERINQUIRIES@DLA.MIL.
16. DLA USE ONLY - VERIFICATIONS AND QFL RECOMMENDATION
CLAUSE
RESULTS
VERIFIER COMMENTS
A. ECHO report reviewed?
B. Is there a history of Significant Non-Compliance (SNC) or High Priority Violations (HPV)?
C. If there is/was a history of non-compliance or SNC/HPV, were corrective actions provided?
D. Were the facility inspection results provided within the last 18 months for CONUS or 36 months for OCONUS? If no, provide justification in comments.
E. If facility received a High Risk or Medium Risk determination from DLA Disposition Services inspection, was evidence of mitigation or corrective action provided?
F. Does the facility ACORD include General and Pollution insurance that is not expired? If the site also requires closure mechanism, was an updated financial closure document provided?
G. Has the Contractor submitted all required documentation and information?
17. RECOMMENDATION
After conducting the review and verifying documentation, I recommend the following:
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/dl0033.pdf none
DL0000
functional title
MONTH 2014
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| AGENCY DISCLOSURE NOTICE |
The public reporting burden for this collection of information, 0704-AQFL, is estimated to average 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
Enter the Official Facility Name. Block 1:
| Enter the Date. Enter the Date as a 2-digit month, 2-digit day, and 4-digit year. Example: 01/01/2023. Block 2.: |
| Enter the Facility I D Number. Block 3.: |
| Enter the Facility Address and Country. Block 4.: |
| Enter the Prime Contractor Name. Block 5.: |
| Enter the Contract Number. Block 6.: |
| Check this box for No. Block 7.: |
| If Yes, , Is the Company / Facility doing business as (DBA), using a different name, or facility name has changed withing the past three years? Provide the name or names. Block 7.: |
| Check this box for Update. Block 8.: |
| Check this box for No. Block 9.: |
| Check this box for No. Block 10.: |
| Other 3: Check this box for Process performed on-site. Block 11.: |
| Other Process Description 3. Enter Other Process Description. Block 11.: |
| Enter any Verifier Comments. Block 16. Row G.: |
| If not Submitted, check this box for No. Block 13. Regulatory and Financial Assurance. Row A.: |
| Enter any Additional Comments. Block 13. Row G.: |
| If not Submitted, check this box for No. Block 13. Regulatory and Financial Assurance. Row B.: |
| If not Submitted, check this box for No. Block 13. Regulatory and Financial Assurance. Row C.: |
| If not Submitted, check this box for No. Block 13. Regulatory and Financial Assurance. Row D.: |
| If not Submitted, check this box for No. Block 13. Regulatory and Financial Assurance. Row E.: |
| Check this box for No, Block 16. Row A.: |
| Check this box for No, Block 16. Row B.: |
| Check this box for No, Block 16. Row C.: |
| Check this box for No, Block 16. Row D.: |
| Check this box for No, Block 16. Row E.: |
| Check this box for No, Block 16. Row F.: |
| Check this box for No, Block 16. Row G.: |
| Check this box for Do not add to Q F L . Block 17. Recommendation. Provide comments below if not adding to Q F L.: |
| Enter Additional Comments.: |
| Enter the Full Name of the D L A Verifier.: |
| Enter the Verifier Signature. This field can be signed electronically.: |
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