Attachment D Surveillance Activity Checklists.pdf

PDF 718 KB Posted Jun 12, 2024

Attached to: Air Emissions
Solicitation number: 2031ZA24Q00228
Issued by: Department of the Treasury Bureau of Engraving and Printing

About this file

Written by GovTribe AI · Jun 12, 2024

This document is an Attachment D Surveillance Activity Checklists related to a federal contract opportunity. It provides a surveillance schedule and activity checklists for monitoring contract performance over a 26-week period. The checklists cover various contract requirements and include details on the method of surveillance, date accomplished, location, and compliance status.

The related federal contract opportunity is for air emissions compliance testing on nickel electroforming and chrome electroplating lines at the Bureau of Engraving and Printing's District of Columbia Facility. The contractor will be required to provide all necessary personnel, equipment, tools, materials, vehicles, and other items and services to perform the testing in accordance with permit requirements and applicable EPA regulations.

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File	Type	Posted
Attachment E Contract Discrepancy Report.pdf	PDF	Jun 12, 2024
Attachment F - Wage Determination No 2015_4281.pdf	PDF	Jun 12, 2024
Attachment 6 - EHS Contractor Requirements Boilerplate EMS Document 75D-07.0-04.pdf	PDF	Jun 12, 2024
Attachment C Customer Complaint Record.pdf	PDF	Jun 12, 2024
Attachment 8 - Sample Port Descriptions.pdf	PDF	Jun 12, 2024
Attachment 7 EPA Test Methods Prior Sampling.pdf	PDF	Jun 12, 2024
Attachment 3 - Permits.pdf	PDF	Jun 12, 2024
Air Emissions RFQ 2031ZA24Q00228_Unrestricted.pdf	PDF	Jun 12, 2024
Attachment B - Quality Assurance Surveillance Plan.pdf	PDF	Jun 12, 2024
Attachment 5 - Plating Line Descriptions.pdf	PDF	Jun 12, 2024
Attachment 4 - Scrubber Descriptions.pdf	PDF	Jun 12, 2024
Attachment A - Performance Work Statement.pdf	PDF	Jun 12, 2024

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5. Planned Date for Surveillance

1. Contract:

3. Surveillance Month:

COR SURVEILLANCE SCHEDULE

2. Contractor:

4. COR:

BEP_OA_SS Rev#1_1-24-18

Attachment D

SURVEILLANCE ACTIVITY CHECKLIST

Date

CONTRACT REQUIREMENT CONTRACT

PARAGRAPH

NUMBER

METHOD OF

SURVEILLANCE

DATE

ACCOMPLISHED

WHERE

ACCOMPLISHED

COMPLIANCE

BEP SAC_Rev #1_1_23_18

TALLY CHECKLIST

CONTRACT NUMBER:

ITEM

INSPECTED

TYPE

SERVICE

DATE

SAT UNSAT REMARKS REC’D DEL’D INSPT’D

BEP_OA_TC_Rev#1_1-24-18

Attachment 3 Surveillance Activity Checklists

Attachment 3 Surveillance Schedule _

Sheet1

Attachment 4 Surveillance Activity Checklist (s)

Attachment 4 -Tally Checklist

1 Contract:

2 Contractor:

Text2:

PWS Paragraph #:

PWS Paragraph #2:

PWS Paragraph #3:

PWS Paragraph #4:

Text7:

Text8:

Text9:

Text10:

Text11:

Date25:

Date7:

Date4: Week 4

3 Surveillance MonthRow2:

3 Surveillance MonthRow2_2:

3 Surveillance MonthRow2_3:

3 Surveillance MonthRow2_4:

4 CORRow2:

4 CORRow2_2:

4 CORRow2_3:

4 CORRow2_4:

4 CORRow2_5:

Date2: Week 2

3 Surveillance MonthRow3:

3 Surveillance MonthRow3_2:

3 Surveillance MonthRow3_3:

3 Surveillance MonthRow3_4:

4 CORRow3:

4 CORRow3_2:

4 CORRow3_3:

4 CORRow3_4:

Date3: Week 3

4 CORRow3_5:

3 Surveillance MonthRow4:

3 Surveillance MonthRow4_2:

3 Surveillance MonthRow4_3:

3 Surveillance MonthRow4_4:

4 CORRow4:

4 CORRow4_2:

4 CORRow4_3:

4 CORRow4_4:

4 CORRow4_5:

3 Surveillance MonthRow5:

3 Surveillance MonthRow5_2:

3 Surveillance MonthRow5_3:

3 Surveillance MonthRow5_4:

4 CORRow5:

4 CORRow5_2:

4 CORRow5_3:

4 CORRow5_4:

4 CORRow5_5:

Date5:

3 Surveillance MonthRow6:

3 Surveillance MonthRow6_2:

3 Surveillance MonthRow6_3:

3 Surveillance MonthRow6_4:

4 CORRow6:

4 CORRow6_2:

4 CORRow6_3:

4 CORRow6_4:

4 CORRow6_5:

Date6:

3 Surveillance MonthRow7:

3 Surveillance MonthRow7_2:

3 Surveillance MonthRow7_3:

3 Surveillance MonthRow7_4:

4 CORRow7:

4 CORRow7_2:

4 CORRow7_3:

4 CORRow7_4:

4 CORRow7_5:

3 Surveillance MonthRow8:

3 Surveillance MonthRow8_2:

3 Surveillance MonthRow8_3:

3 Surveillance MonthRow8_4:

4 CORRow8:

4 CORRow8_2:

4 CORRow8_3:

4 CORRow8_4:

4 CORRow8_5:

Date8:

3 Surveillance MonthRow9:

3 Surveillance MonthRow9_2:

3 Surveillance MonthRow9_3:

3 Surveillance MonthRow9_4:

4 CORRow9:

4 CORRow9_2:

4 CORRow9_3:

4 CORRow9_4:

4 CORRow9_5:

Date9:

3 Surveillance MonthRow10:

3 Surveillance MonthRow10_2:

3 Surveillance MonthRow10_3:

3 Surveillance MonthRow10_4:

4 CORRow10:

4 CORRow10_2:

4 CORRow10_3:

4 CORRow10_4:

4 CORRow10_5:

Date10:

3 Surveillance MonthRow11:

3 Surveillance MonthRow11_2:

3 Surveillance MonthRow11_3:

3 Surveillance MonthRow11_4:

4 CORRow11:

4 CORRow11_2:

4 CORRow11_3:

4 CORRow11_4:

4 CORRow11_5:

Date11:

3 Surveillance MonthRow12:

3 Surveillance MonthRow12_2:

3 Surveillance MonthRow12_3:

3 Surveillance MonthRow12_4:

4 CORRow12:

4 CORRow12_2:

4 CORRow12_3:

4 CORRow12_4:

4 CORRow12_5:

Date12:

3 Surveillance MonthRow13:

3 Surveillance MonthRow13_2:

3 Surveillance MonthRow13_3:

3 Surveillance MonthRow13_4:

4 CORRow13:

4 CORRow13_2:

4 CORRow13_3:

4 CORRow13_4:

4 CORRow13_5:

Date13:

3 Surveillance MonthRow14:

3 Surveillance MonthRow14_2:

3 Surveillance MonthRow14_3:

3 Surveillance MonthRow14_4:

4 CORRow14:

4 CORRow14_2:

4 CORRow14_3:

4 CORRow14_4:

4 CORRow14_5:

Date14:

3 Surveillance MonthRow15:

3 Surveillance MonthRow15_2:

3 Surveillance MonthRow15_3:

3 Surveillance MonthRow15_4:

4 CORRow15:

4 CORRow15_2:

4 CORRow15_3:

4 CORRow15_4:

4 CORRow15_5:

Date15:

3 Surveillance MonthRow16:

3 Surveillance MonthRow16_2:

3 Surveillance MonthRow16_3:

3 Surveillance MonthRow16_4:

4 CORRow16:

4 CORRow16_2:

4 CORRow16_3:

4 CORRow16_4:

4 CORRow16_5:

Date16:

3 Surveillance MonthRow17:

3 Surveillance MonthRow17_2:

3 Surveillance MonthRow17_3:

3 Surveillance MonthRow17_4:

4 CORRow17:

4 CORRow17_2:

4 CORRow17_3:

4 CORRow17_4:

4 CORRow17_5:

Date17:

3 Surveillance MonthRow18:

3 Surveillance MonthRow18_2:

3 Surveillance MonthRow18_3:

3 Surveillance MonthRow18_4:

4 CORRow18:

4 CORRow18_2:

4 CORRow18_3:

4 CORRow18_4:

4 CORRow18_5:

Date18:

3 Surveillance MonthRow19:

3 Surveillance MonthRow19_2:

3 Surveillance MonthRow19_3:

3 Surveillance MonthRow19_4:

4 CORRow19:

4 CORRow19_2:

4 CORRow19_3:

4 CORRow19_4:

4 CORRow19_5:

Date19:

3 Surveillance MonthRow20:

3 Surveillance MonthRow20_2:

3 Surveillance MonthRow20_3:

3 Surveillance MonthRow20_4:

4 CORRow20:

4 CORRow20_2:

4 CORRow20_3:

4 CORRow20_4:

4 CORRow20_5:

Date20:

3 Surveillance MonthRow21:

3 Surveillance MonthRow21_2:

3 Surveillance MonthRow21_3:

3 Surveillance MonthRow21_4:

4 CORRow21:

4 CORRow21_2:

4 CORRow21_3:

4 CORRow21_4:

4 CORRow21_5:

Date21:

3 Surveillance MonthRow22:

3 Surveillance MonthRow22_2:

3 Surveillance MonthRow22_3:

3 Surveillance MonthRow22_4:

4 CORRow22:

4 CORRow22_2:

4 CORRow22_3:

4 CORRow22_4:

4 CORRow22_5:

Date22:

3 Surveillance MonthRow23:

3 Surveillance MonthRow23_2:

3 Surveillance MonthRow23_3:

3 Surveillance MonthRow23_4:

4 CORRow23:

4 CORRow23_2:

4 CORRow23_3:

4 CORRow23_4:

4 CORRow23_5:

Date23:

3 Surveillance MonthRow24:

3 Surveillance MonthRow24_2:

3 Surveillance MonthRow24_3:

3 Surveillance MonthRow24_4:

4 CORRow24:

4 CORRow24_2:

4 CORRow24_3:

4 CORRow24_4:

4 CORRow24_5:

Date24:

3 Surveillance MonthRow25:

3 Surveillance MonthRow25_2:

3 Surveillance MonthRow25_3:

3 Surveillance MonthRow25_4:

4 CORRow25:

4 CORRow25_2:

4 CORRow25_3:

4 CORRow25_4:

4 CORRow25_5:

3 Surveillance MonthRow26:

3 Surveillance MonthRow26_2:

3 Surveillance MonthRow26_3:

3 Surveillance MonthRow26_4:

4 CORRow26:

4 CORRow26_2:

4 CORRow26_3:

4 CORRow26_4:

4 CORRow26_5:

Date26:

3 Surveillance MonthRow27:

3 Surveillance MonthRow27_2:

3 Surveillance MonthRow27_3:

3 Surveillance MonthRow27_4:

4 CORRow27:

4 CORRow27_2:

4 CORRow27_3:

4 CORRow27_4:

4 CORRow27_5:

Date27:

3 Surveillance MonthRow28:

3 Surveillance MonthRow28_2:

3 Surveillance MonthRow28_3:

3 Surveillance MonthRow28_4:

4 CORRow28:

4 CORRow28_2:

4 CORRow28_3:

4 CORRow28_4:

4 CORRow28_5:

Date: Week 1

CONTRACT REQUIREMENTRow1:

CONTRACT PARAGRAPH NUMBERRow1:

METHOD OF SURVEILLANCERow1:

DATE ACCOMPLISHEDRow1:

WHERE ACCOMPLISHEDRow1:

COMPLIANCERow1:

CONTRACT REQUIREMENTRow2:

CONTRACT PARAGRAPH NUMBERRow2:

METHOD OF SURVEILLANCERow2:

DATE ACCOMPLISHEDRow2:

WHERE ACCOMPLISHEDRow2:

COMPLIANCERow2:

CONTRACT REQUIREMENTRow3:

CONTRACT PARAGRAPH NUMBERRow3:

METHOD OF SURVEILLANCERow3:

DATE ACCOMPLISHEDRow3:

WHERE ACCOMPLISHEDRow3:

COMPLIANCERow3:

CONTRACT REQUIREMENTRow4:

CONTRACT PARAGRAPH NUMBERRow4:

METHOD OF SURVEILLANCERow4:

DATE ACCOMPLISHEDRow4:

WHERE ACCOMPLISHEDRow4:

COMPLIANCERow4:

CONTRACT REQUIREMENTRow5:

CONTRACT PARAGRAPH NUMBERRow5:

METHOD OF SURVEILLANCERow5:

DATE ACCOMPLISHEDRow5:

WHERE ACCOMPLISHEDRow5:

COMPLIANCERow5:

CONTRACT REQUIREMENTRow6:

CONTRACT PARAGRAPH NUMBERRow6:

METHOD OF SURVEILLANCERow6:

DATE ACCOMPLISHEDRow6:

WHERE ACCOMPLISHEDRow6:

COMPLIANCERow6:

CONTRACT REQUIREMENTRow7:

CONTRACT PARAGRAPH NUMBERRow7:

METHOD OF SURVEILLANCERow7:

DATE ACCOMPLISHEDRow7:

WHERE ACCOMPLISHEDRow7:

COMPLIANCERow7:

CONTRACT REQUIREMENTRow8:

CONTRACT PARAGRAPH NUMBERRow8:

METHOD OF SURVEILLANCERow8:

DATE ACCOMPLISHEDRow8:

WHERE ACCOMPLISHEDRow8:

COMPLIANCERow8:

CONTRACT REQUIREMENTRow9:

CONTRACT PARAGRAPH NUMBERRow9:

METHOD OF SURVEILLANCERow9:

DATE ACCOMPLISHEDRow9:

WHERE ACCOMPLISHEDRow9:

COMPLIANCERow9:

CONTRACT REQUIREMENTRow10:

CONTRACT PARAGRAPH NUMBERRow10:

METHOD OF SURVEILLANCERow10:

DATE ACCOMPLISHEDRow10:

WHERE ACCOMPLISHEDRow10:

COMPLIANCERow10:

Text1:

ITEM INSPECTED1:

TYPE OF SERVICE1:

RECDRow1:

DEL1:

INSPTD1:

SAT1:

UNSAT1:

REMARKS1:

ITEM INSPECTED2:

TYPE OF SERVICE2:

RECDRow2:

DEL2:

INSPTD2:

SAT2:

UNSAT2:

REMARKS2:

ITEM INSPECTED3:

TYPE OF SERVICE3:

RECDRow3:

DEL3:

INSPTD3:

SAT3:

UNSAT3:

REMARKS3:

ITEM INSPECTED4:

TYPE OF SERVICE4:

RECDRow4:

DEL4:

INSPTD4:

SAT4:

UNSAT4:

REMARKS4:

ITEM INSPECTED5:

TYPE OF SERVICE5:

RECDRow5:

DEL5:

INSPTD5:

SAT5:

UNSAT5:

REMARKS5:

ITEM INSPECTED6:

TYPE OF SERVICE6:

RECDRow6:

DEL6:

INSPTD6:

SAT6:

UNSAT6:

REMARKS6:

ITEM INSPECTED7:

TYPE OF SERVICE7:

RECDRow7:

DEL7:

INSPTD7:

SAT7:

UNSAT7:

REMARKS7:

ITEM INSPECTED8:

TYPE OF SERVICE8:

RECDRow8:

DEL8:

INSPTD8:

SAT8:

UNSAT8:

REMARKS8:

ITEM INSPECTED9:

TYPE OF SERVICE9:

RECDRow9:

DEL9:

INSPTD9:

SAT9:

UNSAT9:

REMARKS9:

ITEM INSPECTED10:

TYPE OF SERVICE10:

RECDRow10:

DEL10:

INSPTD10:

SAT10:

UNSAT10:

REMARKS10:

ITEM INSPECTED11:

TYPE OF SERVICE11:

RECDRow11:

DEL11:

INSPTD11:

SAT11:

UNSAT11:

REMARKS11:

ITEM INSPECTED12:

TYPE OF SERVICE12:

RECDRow12:

DEL12:

INSPTD12:

SAT12:

UNSAT12:

ITEM INSPECTED13:

REMARKS12:

TYPE OF SERVICE13:

RECDRow13:

DEL13:

INSPTD13:

SAT13:

UNSAT13:

REMARKS13:

ITEM INSPECTED14:

TYPE OF SERVICE14:

RECDRow14:

DEL14:

INSPTD14:

SAT14:

UNSAT14:

REMARKS14:

ITEM INSPECTED15:

TYPE OF SERVICE15:

RECDRow15:

DEL15:

INSPTD15:

SAT15:

UNSAT15:

REMARKS15:

ITEM INSPECTED16:

TYPE OF SERVICE16:

RECDRow16:

DEL16:

INSPTD16:

SAT16:

UNSAT16:

REMARKS16:

ITEM INSPECTED17:

TYPE OF SERVICE17:

RECDRow17:

DEL17:

INSPTD17:

SAT17:

UNSAT17:

REMARKS17:

ITEM INSPECTED18:

TYPE OF SERVICE18:

RECDRow18:

DEL18:

INSPTD18:

SAT18:

UNSAT18:

REMARKS18:

File details come from the government source that posted it. Updated Jun 12, 2024.