CN-370000-HW687-DC002B.pdf

Funding Information:

Org. Code E.O. Object Code Budget Entity Appropriation

Category Grant # Project # Year Amount

☐ Additional Funding Information attached on separate page.

Rev. 8/26/2020

STATE OF FLORIDA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

Task Assignment This Task Assignment (TA) is entered into between the Parties named below, pursuant to Contract Number: .

1. TA Number: TA Completion Date:

TA Description:

2. Parties State of Florida Department of Environmental Protection

(Department)

Department Project Manager: Department Project Manager Phone:

Contractor Name: (Contractor ) ntractor’st ’s Project Manager: ontractor’s t’s Project Manager Phone:

3. Project Number:

(If different from TA Number)

Project Location(s):

Project Name:

4. As consideration for the services rendered by Contractor under the terms of this TA, the Department shall pay the Contractor on the following bases, up to the Total TA Value as indicated below:

☐ Fixed Price:

☐ Fixed Unit Rate: (Extended Price)

☐ Cost Reimbursement:

Total TA Value:

5. The Parties agree to comply with the terms and conditions of the underlying the Contract, and the following attachments which are hereby incorporated by reference:

Attachment 1:

☐ Additional Attachments (if necessary):

IN WITNESS WHEREOF, this TA shall be effective on the last date signed below.

State of Florida Department of Environmental Protection CONTRACTOR Department Name:

Title:

Secretary or Designee

(Authorized Signature) (Authorized Signature) Date:

☐ Additional signatures attached on separate page.

HW687

DC002B Completion May 31, 2023

This TA authorizes costs for SVE O&M, inluding restart system sampling & analysis and system evaluation/reporting. The total cost for this TA is $9,826.05. Cost reimbursement accounts for $2,000 of the total cost.

Dean Cox 850-245-8969 Contractor Contractor

Contractor Contractor

Contractor Contractor

Contractor

Terracon Consultants, Inc.

Terracon Consultants, Inc.

Donna Cline 813-321-0340

ERIC_5205

2100 45th Street, Unit B8 West Palm Beach

Village Cleaners (former)

✔ $ 7,826.05 ✔ $ 2,000.00

$ 9,826.05

Scope of Work

Tom Lewis

Principal

Lewis, Tom E Digitally signed by Lewis, Tom E Date: 2022.10.18 11:15:17 -04'00'

Jennifer Farrell

Digitally signed by Jennifer Farrell Date: 2022.10.18 07:46:21 -04'00'

N/A

Task Assignment Notification/Change Order Deliverables and Invoice Schedule Attachment

WCP TAFORM 04-2017

Contract Number:

Task Assignment #:

Deliverables:

Deliverable Deliverable Due Date

Invoice Schedule:

Requirements for Invoice Submittal Amount to be Invoiced

TOTAL COST

Monthly O&M checklists and field notes, lab reports for two system sampling events, O&M tables update, and system evaluation email with recommendations. (Subtask 1 Project Management and Subtask 2 Three Months O&M)

03/31/2023

FDEP approval of monthly O&M checklists and field notes, lab reports for two system sampling events, O&M tables update, and system eval email with recommendations.

(Subtask 1 Project Management and Subtask 2 Three Months O&M)

$ 7,746.05

FDEP receipt of utility invoices - Utilities Cost Reimbursement not to exceed $2000;

Utilities Handling Fee $80 (Subtask 3 Utilities) $ 2,080.00

$ 9,826.05

HW687

DC002B

FLORIDA DEPARTMENT OF

Environmental Protection

Bob Martinez Center

2600 Blair Stone Road Tallahassee, FL 32399-2400

Ron DeSantis Governor

Jeanette Nuñez

Lt. Governor

Shawn Hamilton Interim Secretary

Memorandum

TO: HW687 Contract File FROM: Dean Cox, Contract Manager SUBJECT: SVE O&M DC002B for Village Cleaners ERIC_5205

DATE: 10/14/2022

This TA authorizes costs for SVE O&M, including system restart sampling & analysis and system evaluation/reporting, based on the Terracon TA proposal letter and cost estimate dated 9/27/22. The total cost for this TA is $9,826.05. Cost reimbursement accounts for $2,000 of the total cost.

The cost of this TA was negotiated. The total cost is $848.02 less than originally proposed. Negotiation resulted in a cost savings of approximately 8%.

The system has been operational since January 2019, but the capacitors failed sometime between the May and June O&M visits. Recent contaminant recovery has been relatively low, but high enough to continue running – only VEW-3 and VEW-4 will be on, which has been the situation for a few months (per WSCS PE 7/19/22 email). The other wells had not been recovering contamination.

The capacitors will be replaced and a “pulse/shutdown evaluation” will be completed (per WSCS PE 7/19/22 email, FDEP guidelines, and WSCS PE verbal guidance [purge volume evacuation not to exceed one hour]) when the system is re-started on the first O&M visit (wells & influent sampling). Two additional O&M visits will be completed, with an operational verification visit (no O&M) in-between. The system wells and influent will also be sampled during the third O&M visit (four months from the first visit). Site access has been confirmed – the agreement is current/accurate.

FDEP COST ESTIMATE

Contractor: Terracon

Date: 9/27/2022 Task #: HW687 DC002B SubTask 1 Project Management SubTask 6

Site: Village Cleaners ERIC_5205 SubTask 2 Three Months SVE O&M, 4 months operation SubTask 7 Activity/Phase: SVE O&M, 4 months operation SubTask 3 Utilities SubTask 8

Project Manager: Dean Cox SubTask 4 SubTask 9 SubTask 5 SubTask 10

Totals 1 2 3 4 5 6 7 8 9 10 Labor Rate Category

$64.50 Project Manager Donna Cline 2.54 2.54 $0.00 Administrative 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Brownfield Consultant 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

$21.25 CADD Specialist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Data Analyst & Visualization Specialist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

$24.75 Environmental Technician Pete Christianson 30.00 30.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Field Geologist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Field Scientist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 GIS Technician 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Principal Consultant 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

$32.00 Project Geologist Joshua Feltner 2.00 2.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Project Industrial Hygienist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Project Scientist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

$64.50 Senior Engineer Donna Cline 5.00 5.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Senior Geologist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Senior GIS Analyst 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Senior Industrial Hygienist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Senior Scientist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

$29.28 Staff Engineer Eddy Leon 4.50 4.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Staff Scientist 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Total Hours 44.04 2.54 41.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Direct Labor $1,424.66 $163.90 $1,260.76 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Overhead 116.00% $1,652.60 $190.12 $1,462.48 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Gen & Admin 0.00% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Fringe 56.26% $801.51 $92.21 $709.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Labor $3,878.77 $446.23 $3,432.54 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

REV: 02/03 CEF TERRACON Page 1

FDEP COST ESTIMATEContractor: Terracon Date: 9/27/2022

Task #: HW687 DC002B SubTask 1 Project Management SubTask 6 Site: Village Cleaners ERIC_5205 SubTask 2 Three Months SVE O&M, 4 months operation SubTask 7

Activity/Phase: SVE O&M, 4 months operation SubTask 3 Utilities SubTask 8 Project Manager: Dean Cox SubTask 4 SubTask 9

SubTask 5 SubTask 10

Totals 1 2 3 4 5 6 7 8 9 10 Travel

Vehicle Rental $480.00 480.00$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Mileage Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Air Fare $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Per diem + Hotel $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Travel $480.00 $480.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor (Equipment Procurement) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor Subtotal $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Procurement Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Subcontractor Cost $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor (Services Procurement) Drilling (Conventional) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Drilling (Non-conventional) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Mobile Laboratory $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Surveying $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

IDW $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Utilities $2,000.00 $0.00 2,000.00$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subcontractor Subtotal $2,000.00 $0.00 $2,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Handling Fee $80.00 $0.00 80.00$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Subcontractor Cost $2,080.00 $0.00 $2,080.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Laboratory Analytical Costs $1,398.00 1,398.00$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Fast Turnaround Charges $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Sample Shipping $104.00 104.00$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Laboratory $1,502.00 $1,502.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Field Expenses Personal Protection $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Expendables $120.00 120.00$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (Drilling related) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (Analytical related) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (IDW related) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Equipment (Other) $1,377.41 1,377.41$ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Field Expenses $1,497.41 $1,497.41 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Subtotal $9,438.18 $446.23 $6,911.95 $2,080.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Completion Fee $387.87 $44.62 $343.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Total Estimated Cost $9,826.05 $490.85 $7,255.20 $2,080.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

REV: 02/03 CEF TERRACON Page 2

LEVEL OF EFFORT/EXPENSE WORKSHEET

SITE : Village Cleaners ERIC_5205 SUBTASK 2: 3 Months of O&M

PROPOSAL NO. PH4227314

DATE: 9/27/2022

LABOR CATEGORY *PROVIDE TIME REQUIRED FOR EACH PERSON

STAFF-TITLE WORK DESCRIPTION HOURS

Month 1 O&M, Restart/Pulse Staff Engineer EL 0.5 Staff Engineer EL 0.5 Environmental Technician PC Load/unload 1.0 Environmental Technician PC Mobilization (from Winter Park) 5.0 Environmental Technician PC Replace capacitors 1.0 Environmental Technician PC System O&M, Optimization, collect samples from SVE001, SVE002 and influent 4.0 Staff Engineer EL Monthly recording of system data and laboratory data into the operational tables 1.5 Senior Engineer DC

1.5

Month 2 O&M (approximately 30 days after Month 1 O&M visit) Environmental Technician PC Load/unload 1.0 Environmental Technician PC Mobilization (from Winter Park) 5.0 Environmental Technician PC O&M, optimize performance 3.0 Staff Engineer EL Monthly recording of system data into the operational tables 1.0 Senior Engineer DC Evaluate O&M Checklist, field notes, and operational tables 1.0

Month 3 Visit (verify system operation) Project Geologist JF Mobilization (from West Palm Office) 1.0 Project Geologist JF Verify system operation, record hour meter reading, restart sytem if necessary 1.0

Month 4 O&M (approximately 60 days after Month 2 O&M visit) Environmental Technician PC Load/unload 1.0 Environmental Technician PC Mobilization (from Winter Park) 5.0 Environmental Technician PC O&M, optimize, collect samples from SVE001, SVE002 and system influent 4.0 Staff Engineer EL Monthly recording of system and lab data into the operational tables 1.0 Senior Engineer DC 2.5

TOTAL LABOR 41.5

VEHICLE TYPE RATE UNIT USEAGE

Truck (Environmental Technician) 120 day 3 360.00$ Truck (Project Geologist) 120 day 1 120.00$

TOTAL VEHICLE 480.00$

LABORATORY COSTS

PARAMETER RATE # SAMPLES #QAQC* #IDW TOTALS

VOCs TO-15 (VEW-1, -2, total) 200.00$ 6 1,200.00$

Summa Canister 33.00$ 6 198.00$ Sample Shipping Small Cooler (2 day) 52.00$ 2 104.00$

TOTAL LAB 1,502.00$

EQUIPMENT ITEM RATE COSTING UNIT USEAGE TOTALS

Construction / O&M / Pilot Test Kit 360.00$ day 3 1,080.00$ Construction / O&M Supplies 75.00$ day 3 225.00$ 20UD64 Motor Run Capacitor 46.07$ each 1 46.07$ 4UHC7 Motor Start Capacitor 26.34$ each 1 26.34$ Expendables 40.00$ day 3 120.00$

TOTAL EQUIPMENT 1,497.41$

Request sample kit PreTask Planning, prepare field sampling SOW/coordinate site access

Submit O&M Checklist, field notes, operational tables, and email evaluation/recommendations

Evaluate O&M Checklist, field notes, operational tables, and lab data - provide update to FDEP

LEVEL OF EFFORT/EXPENSE WORKSHEET

SITE : Village Cleaners ERIC_5205 SUBTASK 3: Utilities

PROPOSAL NO. PH4227314

DATE: 9/27/2022

LABOR CATEGORY *PROVIDE TIME REQUIRED FOR EACH PERSON

STAFF-TITLE WORK DESCRIPTION HOURS

TOTAL LABOR 0.0

VEHICLE TYPE RATE UNIT USEAGE

TOTAL VEHICLE -$

PER DIEM STAFF RATE UNIT USEAGE

TOTAL PER DIEM -$

SUBCONTRACTOR COSTS

NAME PURPOSE COST UNIT USEAGE

FP&L Initiation Fee 225.00$ lump sum 0 -$ FP&L Electric 500.00$ Month 4 2,000.00$

Subcontractor Handling Fee 20.00$ Month 4 80.00$

TOTAL SUBCONTRATOR 2,080.00$

LABORATORY COSTS

PARAMETER RATE # SAMPLES #QAQC* #IDW TOTALS

TOTAL LAB -$

EQUIPMENT ITEM RATE COSTING UNIT USEAGE TOTALS

TOTAL EQUIPMENT -$

5463 West Waters Avenue, Suite 830

Tampa, FL 33584

P (813) 221-0050

F (813) 221-0051

Terracon.com

September 27, 2022

Florida Department of Environmental Protection

Waste Cleanup Program

Waste Management Division

2600 Blair Stone Road

Tallahassee, Florida 32399-2400

Attn: Mr. Dean Cox, Environmental Consultant

E: Dean.Cox@FloridaDep.gov

W: 850-245-8969

M: 727-686-6502

Re: Proposal for SVE Shutdown Evaluation and 4 Months of System Operation

Village Cleaners

2100 45th Street, Unit B8

West Palm Beach, Palm Beach County, Florida

ERIC_5205

Task Assignment HW687 DC002B

Terracon Proposal No. PH4227314

Dear Mr. Cox:

Terracon Consultants, Inc. (Terracon) appreciates the opportunity to submit this proposal to the

Florida Department of Environmental Program (FDEP) Waste Cleanup Program (WCP) to perform remedial system shutdown evaluation on the soil vapor extraction (SVE) system at Village Cleaners.

Scope of Services

◼ Initial site visit (after a brief period of non-operation) includes troubleshooting and system repairs (replacing capacitors);

◼ The system will operate for a period of 4 months;

◼ Perform first, second, and fourth month of system Operation and

Maintenance (O&M) with operation of SVE001 and SVE002 only;

◼ Collect air samples for laboratory analysis at initial site visit and at the fourth month of O&M;

◼ The initial site visit will include an evaluation for system shutdown, with air sample collection after the removal of 1 pore volume of air (approximately 1 hour of operation);

◼ Submit O&M checklist, field notes, operational tables, lab data, and email evaluation / recommendations.

See attached LOE for details

Schedule

◼ System troubleshoot, to include replacing capacitors, and system restart by October 2022, depending on issuance of TA

◼ Submit e-mail summary at completion of 4 months of operation to include O&M checklists and field notes, laboratory analytical data, O&M tables, and email summary with system performance evaluation and recommendations by February 2023.

GRAINGER ..

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8001 FORSHEE D R IVE

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W INTER PARK FL 32789-2207

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1675 LEE RD

WINTER PARK FL 32789-2207

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PACKING LIST

Include Stuffers

BOX ID 2021685~2

PO Number PETER CHRISTENSON

Delivery Number 6553731820 Account Number 835850892

Caller PETER CHRISTENSON PO Release Number Project/Job Number

Department Order Date 06/15/2022

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Order Type SH Debit/Credit Code MRCD Cartons Shipped

SPECIAL INSTRUCTIONS Please reference DELIVERY NUMBER 6553731 820 on all remittance and correspondence.

PO Line Item# Item Description

20UD64 Motor Run Capacitor,60 MFD,4 11 /32" H

4UHC7 Motor Start Capacitor,645-774 MFD,Round

Your Order Number is : 1450222949

Quantity Shipped

Shipped from other location

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0 T 43.25

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Subtotal Tax Stand. Parcel Shipping Other Shipping

Total

W e'd love to hear your feedback about this order. Go to www.grainger.com/survey and tell us what you think.

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43.25

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46.07

THIS PURCHASE IS GOVERNED EXCLUSIVELY BY GRAINGER'S TERMS OF SALE, INCLUDING (i ) DISPUTE RESOLUTION REMEDIES, AND (ii ) CERTAIN WARRANTY AND DAMAGES LIMITATIONS AND DISCLAIMERS IN EFFECT AT THE TIME OF THE ORDER, WHICH ARE INCORPORATED BY REFERENCE HEREIN. GRAINGER'S TERMS OF

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SOLD TO ACCOUNT 835850892

TERRACON

1675 LEE RD

WINTER PARK FL 32789-2207

CALLER

PETER CHRISTENSON

TELEPHONE NUMBER

4075094127

SHIP TO

TERRACON

1675 LEE RD

WINTER PARK FL 32789-2207

ATTENTION

ITEM DESCRIPTION

Motor Start Capacitor,645-774 MFD,Round

THIS PURCHASE IS GOVERNED EXCLUSIVELY BY GRAINGER'S

TERMS OF SALE, INCLUDING: {i) DISPUTE RESOLUTION REMEDIES, AND (ii) CERTAIN WARRANTY AND DAMAGES

LIMITATIONS ANO DISCLAIMERS IN EFFECT AT THE TIME OF THE

ORDER, W'HICH ARE INCORPORATED BY REFERENCE HEREIN

GRAINGER'S TERMS OF SALE ARE AVAILABLE AT

WWW.GRAINGER.COM

PRODUCT RETURN INSTRUCTIONS ARE AVAltABLE AT

WWW.GRAINGER.COM/RETURNS

PURCHASE ORDER NUMBER

PETER CHRISTENSON

I L.IL. I n.1'\l1Y1L.1 l'\I UIVlOl:.I

REQUISITIONER

PROJECT/JOB NUMBER

PO RELEASE NUMBER

SPECIAL INSTRUCTIONS

CARRIER NAME

NONE

ITEM NUMBER SHIP QTY

4UHC7

GRAINGER®

/II IJl'i#-!-IWJ-/ iii iil·ldiiii·M ti

SAP DELIVERY

6553731819

PACKING LIST

DELIVERY DATE AND TIME EMPLOYEE I PAGE

06/15/2022 12:45 BR3C1L 1 OF 1

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MRCD 1450222949 6553731819

BRANCH ADDRESS

4180 LB MCLEOD

ORLANDO FL 32811-5695

407-843-3220 CHECK NUMBER I CHECK AMOUNT I CASH REC'D/PAID f g;;Ns TYPE

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THANK YOU FOR YOUR ORDER

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I certify lhat if I am purchasing lhe maleria~s) as •materiaLs of trade· as defined in the Hazardous Materias RegUations in Title 49 of the Code of Federal Regulations. I intend to use the materia(s) in direct support ofmy principal business (....tich is not transportation), and I do not irtend to resell the material, or transport them in a vehicle other than my O'Ml.

I DA1E SHIPPED/PICKED UP

UNIT PRICE

24.74

Stand. Parcel Shipping Other Shipping Tax Total

Vi.sit our web site @ www.grainger.rom

TOTAL

24.74

0.00 0.00 1.60

26.34

These items are sold for domestic ooosurrl)C.On in the United States. If exp;:111ed, pudlaser assumes ful resp:,l"ISlb.lity for oo!'l"Piance 'Mth US exlX)rt oontrols. I llllll 111111111111111 1111111111 1111111111 11111 1111111111111

GRAINGER.

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4180 LB MCLEOD

ORLANDO FL 32811-5695

TO:

TERRACON

1675LEERD

WINTER PARK FL 32789-2207

4075094127

06/15/2022 Delivery# 6553731819

TELEPHONE#

PO NUMBER

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PETER CHRISTENSON

CALLER PETER CHRISTENSON

GRAINGER.

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4180 LB MCLEOD

ORLANDO FL 32811-5695

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1675LEERD

WINTER PARK FL 32789-2207

4075094127

06/15/2022 Delivery# 6553731819

TELEPHONE#

PO NUMBER

ATTENTION

PROJECT/JOB#

DEPARTMENT #

PO RELEASE

PETER CHRISTENSON

CALLER PETER CHRISTENSON

{"type":"Imported Receipt","isBackSide":false,"languages":["en-us"],"usedOnDeviceOCR":true}

{"type":"Imported Receipt","isBackSide":false,"languages":["en-us"],"usedOnDeviceOCR":true}