Attachment 8 - Form 2593_Verifcation of W. Removal.pdf

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PDF (DLA)

DLA FORM 2539, APR 2019

CUSTOMER'S VERIFICATION OF WASTE REMOVAL

Prescribed by: SOP 4700.01 Sponsor: Disposition Services Page of

REPLACES DLA DISP SVCS FORM 1729A, WHICH IS OBSOLETE

This form is for use by the Customer when the DLA Disposition Services Contracting Officer's Representative (COR) is NOT PRESENT at the time of waste removal. It is not intended to represent a formal acceptance of services provided under the referenced contract. Its only purpose is to provide a record that the specific waste items indicated on the Task Order (DD Form 1155) were removed by the contractor on the date indicated.

SECTION I (To be completed by the COR before being given to the customer) SECTION II (To be completed by the customer verifying the waste removal) NOTE TO CUSTOMER: Neither you, nor the COR, are authorized to direct or allow the contractor to perform any work which is not specifically identified in the Task Order. Only the KO has that authority. Any requests for changes to what is ordered on the Task Order must be approved by the KO, before removal or other work takes place. If changes are needed, contact your COR before proceeding and explain any changes in “Remarks”.

Please answer the following questions. If your answer for 1 through 6 or 8 through 11 is “no” then check “no” and contact the COR immediately for instructions. If the COR resolves the issue(s), and all parties agree to continue with the removal, then explain further in the remarks section on the next page.

YES

NO

SEE REMARKS

Questions 1-4 should be answered before allowing any work to begin

1. Did the contractor arrive on the pre-arranged date & time?

2. Does the contractor have sufficient equipment & personnel and act in a professional manner?

3. Is the carrier's vehicle suitable for hauling hazardous material and in good condition?

4. Is the Driver in possession of all necessary hauling permits and a commercial driver's license with a HAZMAT endorsement, which has been previously verified by a DLA Disposition Services COR?

Questions 5-8 should be answered prior to final release of the waste shipment.

5. Has the COR/Contractor annotated the Task Order and Shipping paper(s) to reflect what was actually shipped?

6. Did you sign the Shipping Papers and receive a receipt copy from the carrier?

7. Did the contractor provide you with copies of all other pertinent documents?

8. Were you satisfied with how the removal went?

Thank you for your assistance. Please sign and date below and provide a copy of this form, a copy of the completed Task Order and associated HW Manifests/Shipping Papers, and any other pertinent documents to your COR as soon as possible.

SECTION III - CUSTOMER'S VERIFICATION STATEMENT

I hereby attest that the line item(s) on the Task Order listed above, which are described and listed on the HW Manifest number(s) listed above, were removed by the contractor on this date.

REMARKS

Example: Question 5 Upon re-weighing Line Item 3 of the Task Order, it was discovered to weigh 5 pounds more than first described. I contacted the COR, who then contacted the KO for a modification adding the weight. Upon discussion with the Contractor, the KO modified Line Item 3 to reflect the extra 5 pounds, and it was removed as requested.

Hansen, Gary B CIV DLA DISPOSITION SERVICES (US)

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Moore, Liberty D CIV DLA DISPOSITION SERVICES (US) Microsoft Office Word

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