Corporate Disposal Contract CDRLs -A001-A005.pdf

Rev II 04/26/2018

CONTRACT DATA REQUIREMENTS LIST

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). 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. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

RADIOACTIVE WASTE DISPOSAL

E. CONTRACT/PR NO.

N42158-24-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A001

2. TITLE OF DATA ITEM

CERTIFICATE OF DISPOSAL

3. SUBTITLE

CERTIFICATE OF DISPOSAL

4. AUTHORITY (Data Acquisition Doc. No)

DI-MGMT-82372

5. CONTRACT REFERENCE

SOW, PARA, 3.5.1

6. REQUIRING OFFICE

NNSY CODE 106.4 (LSMM)

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

SEE BLK 16

12. DATE OF FIRST SUBMISSION

SEE BLK 16

14. DISTRIBUTION

8. APP CODE

N/A

11. AS OF DATE

13. DATE OF SUBSEQUENT

SUBMISSION

SEE BLK 16

ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 9: DISTRIBUTION STATEMENT “A”. APPROVED FOR PUBLIC RELEASE;

DISTRIBUTION UNLIMITED.

BLKS 10, 12, 13: THE CERTIFICATE OF DISPOSAL SHALL BE PROVIDED WITHIN TEN

(10) DAYS OF DISPOSAL DATE.

BLK 14: DISTRIBUTION SHALL BE TO THE CONTRACTING OFFICER’S

REPRESENTATIVE (COR) AND THE NNPP SITE TECHNICAL PERSONNEL AS SET

FORTH IN EACH INDIVIDUAL TASK ORDER. DISTRIBUTION SHALL BE VIA FAX, HARD

COPY, OR BY ELECTRONIC METHOD, AS DIRECTED BY THE GOVERNMENT.

POC(s):

NNSY C106.4 COR: KRISTIN CORRIE

PHONE: (757) 396-2432

EMAIL: kristin.s.corrie.civ@us.navy.mil

NNSY

C106.4 COR

NNPP SITE 1

15. TOTAL 2

G. PREPARED BY

Kristin Corrie

H. DATE

09/27/2023

I. APPROVED BY

J. DATE

17. PRICE

GROUP

18. ESTIMATED

TOTAL PRICE

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). 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. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

RADIOACTIVE WASTE DISPOSAL

E. CONTRACT/PR NO.

N42158-24-TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A002

2. TITLE OF DATA ITEM

RADIOLOGICAL SURVEY RESULTS

3. SUBTITLE

RADIOLOGICAL SURVEY RESULTS

4. AUTHORITY (Data Acquisition Doc. No)

DI-TCSP-82413

5. CONTRACT REFERENCE

SOW, PARA, 3.5.2

6. REQUIRING OFFICE

NNSY CODE 106.4 (LSMM)

7. DD 250 REQ

N/A

B

ASREQ

(SEE BLK 16)

12. DATE OF FIRST SUBMISSION

ASREQ

(SEE BLK 16)

See BLK 16

SUBMISSION

See BLK 16 ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 9: DISTRIBUTION B. DISTRIBUTION AUTHORIZED TO U.S. GOVERNMENT

AGENCIES (FOR OFFICIAL USE ONLY) (09 AUGUST 2023). OTHER REQUESTS FOR

THIS DOCUMENT SHALL BE REFERENCED TO LEAD SHIPYARD FOR MIXED

MATERIAL, CODE 106.4, BLDG. M22-3 ROOM 317, NORFOLK NAVAL SHIPYARD,

PORTSMOUTH, VA 23709-1035.

BLKs 10, 12, 13: RADIOLOGICAL SURVEY RESULTS SHALL BE PROVIDED UPON

REQUEST BY EITHER THE CONTRACTING OFFICER’S REPRESENTATIVE (COR) OR

THE NAVAL NUCLEAR PROPULSION PROGRAM (NNPP) SITE TECHNICAL

PERSONNEL.

BLK 14: DISTRIBUTION SHALL BE TO THE CONTRACTING OFFICER’S

REPRESENTATIVE (COR) AND THE NNPP SITE TECHNICAL PERSONNEL AS SET

FORTH IN EACH INDIVIDUAL TASK ORDER. DISTRIBUTION SHALL BE VIA FAX, HARD

COPY, OR BY ELECTRONIC METHOD, AS DIRECTED BY THE GOVERNMENT.

POC(s):

NNSY C106.4 COR: KRISTIN CORRIE

Kristin Corrie

H. DATE

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). 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. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

RADIOACTIVE WASTE DISPOSAL

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A003

2. TITLE OF DATA ITEM

ASBESTOS WASTE DOCUMENTATION

3. SUBTITLE

ASBESTOS WASTE DOCUMENTATION

4. AUTHORITY (Data Acquisition Doc. No)

DI-MGMT-82396

5. CONTRACT REFERENCE

SOW, PARA, 3.5.3

6. REQUIRING OFFICE

NNSY CODE 106.4 (LSMM)

7. DD 250 REQ

N/A

SEE BLK 16

12. DATE OF FIRST SUBMISSION

SUBMISSION

SEE BLK 16

ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 9: DISTRIBUTION STATEMENT “A”. APPROVED FOR PUBLIC RELEASE;

DISTRIBUTION UNLIMITED.

BLKs 10, 12, 13: A COPY OF ALL SIGNED ASBESTOS WASTE DOCUMENTATION

SHALL BE PROVIDED WITHIN TEN (10) DAYS OF SHIPMENT RECEIPT AT THE

DISPOSAL FACILITY.

BLK 14: DISTRIBUTION SHALL BE TO THE CONTRACTING OFFICER’S

REPRESENTATIVE (COR) AND THE NNPP SITE TECHNICAL PERSONNEL AS SET

FORTH IN EACH INDIVIDUAL TASK ORDER. DISTRIBUTION SHALL BE VIA FAX, HARD

COPY, OR BY ELECTRONIC METHOD, AS DIRECTED BY THE GOVERNMENT.

POC(s):

NNSY C106.4 COR: KRISTIN CORRIE

Kristin Corrie

H. DATE

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). 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. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

RADIOACTIVE WASTE DISPOSAL

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A004

2. TITLE OF DATA ITEM

WASTE STATUS REPORT

3. SUBTITLE

WASTE STATUS REPORT

4. AUTHORITY (Data Acquisition Doc. No)

DT-MGMT-82375 (SEE BLK 16)

5. CONTRACT REFERENCE

SOW, PARA, 3.5.4

6. REQUIRING OFFICE

NNSY CODE 106.4 (LSMM)

7. DD 250 REQ

N/A

B (SEE BLK 16)

MTHLY &

ANNLY (SEE

BLK 16)

12. DATE OF FIRST SUBMISSION

SUBMISSION

SEE BLK 16

ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 4: ONLY CONTENT DESCRIBED IN 3.b, 3.c, 3.o, 3.p, 3.q AND 3.r APPLIES.

BLK 9: DISTRIBUTION B. DISTRIBUTION AUTHORIZED TO U.S. GOVERNMENT

AGENCIES (FOR OFFICIAL USE ONLY) (09 AUGUST 2023). OTHER REQUESTS FOR

THIS DOCUMENT SHALL BE REFERENCED TO LEAD SHIPYARD FOR MIXED

MATERIAL, CODE 106.4, BLDG. M22-3 ROOM 317, NORFOLK NAVAL SHIPYARD,

PORTSMOUTH, VA 23709-1035.

BLKs 10, 12 & 13: THE MONTHLY REPORT SHALL BE PROVIDED BY THE 10TH DAY OF

EACH MONTH THE CONTRACT IS IN EFFECT. THE ANNUAL REPORT SHALL BE

PROVIDED BY JANUARY 5TH OF EACH YEAR THE CONTRACT IS IN EFFECT.

BLK 14: DISTRIBUTION SHALL BE TO THE CONTRACTING OFFICER’S

REPRESENTATIVE (COR) AND THE NNPP SITE TECHNICAL PERSONNEL AS SET

FORTH IN EACH INDIVIDUAL TASK ORDER. DISTRIBUTION SHALL BE VIA FAX, HARD

COPY, OR BY ELECTRONIC METHOD, AS DIRECTED BY THE GOVERNMENT.

POC(s):

NNSY C106.4 COR: KRISTIN CORRIE

PHONE: (757) 396-2432

EMAIL: kristin.s.corrie.civ@us.navy.mil

NNSY

C106.4 COR

Kristin Corrie

H. DATE

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). 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. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

RADIOACTIVE WASTE DISPOSAL

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO

A005

2. TITLE OF DATA ITEM

WASTE SHIPPING DOCUMENTATION

3. SUBTITLE

WASTE SHIPPING DOCUMENTATION

4. AUTHORITY (Data Acquisition Doc. No)

DI-MGMT-82374

5. CONTRACT REFERENCE

SOW, PARA, 3.5.5

6. REQUIRING OFFICE

NNSY CODE 106.4 (LSMM)

7. DD 250 REQ

N/A

ASGEN SEE

BLK 16

12. DATE OF FIRST SUBMISSION

SUBMISSION

SEE BLK 16

ADDRESSEES Draft

Final

Reg Repro

16. REMARKS

BLK 4: ONLY CONTENT DESCRIBED IN 3.a, 3.c, AND 3.f APPLY.

BLK 9: DISTRIBUTION STATEMENT “A”. APPROVED FOR PUBLIC RELEASE;

DISTRIBUTION UNLIMITED.

BLKs 10, 12, 13: COPIES OF SIGNED MANIFESTS SHALL BE PROVIDED WITHIN TEN

(10) DAYS OF RECEIPT AT THE DISPOSAL FACILITY.

BLK 14: DISTRIBUTION SHALL BE TO THE CONTRACTING OFFICER’S

REPRESENTATIVE (COR) AND THE NNPP SITE TECHNICAL PERSONNEL AS SET

FORTH IN EACH INDIVIDUAL TASK ORDER. DISTRIBUTION SHALL BE VIA FAX, HARD

COPY, OR BY ELECTRONIC METHOD, AS DIRECTED BY THE GOVERNMENT.

POC(s):

NNSY C106.4 COR: KRISTIN CORRIE

Kristin Corrie

H. DATE