Exhibit 3 Army Recycling Program Summary of Petroleum Oil Lubricant (POL) Diversion.pdf

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Testing, Pick up and Disposal of Petroleum, Oil and Lubricant (POL)
Solicitation number
W912CN-26-Q-A018
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This is a monthly reporting template for the Summary of Petroleum/Oil/Lubricant (POL) Diversion form used by the Department of Public Works (DPW) Recycling Program at an Army installation. The form requires submission by email to kimberly.m.welch14.civ@army.mil on a monthly basis, effective as of January 1, 2026.

The form captures diversion quantities for eight categories of petroleum and lubricant materials: Antifreeze (gallons), JP-8 (gallons), Oily Water (gallons), Used Motor Oil (gallons), Grease (pounds), Gas/Mogas (gallons), Diesel Fuel (gallons), and Other (customizable). Each monthly submission must include the completed POL Diversion summary form along with copies of the Daily Log and Monthly POL Request Log. The form requires identification information including the company name, person completing the form, contact phone number, signature, and the period covered (from and to dates). The form is designated as requiring a "Negative Response Required," indicating that even months with no diversion activity must be reported. This template is designed for contractors or service providers managing petroleum product diversion and recycling operations on military installations.

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Revised 01/01/2026Each month, Email the following to kimberly.m.welch14.civ@army.mil (DPW Recycling Program):

1. This Completed Summary of POL Diversion form

2. Copies of Daily Log

3. Copy of Monthly POL Request Log

JP-8 (gal) Oily Water (gal) Used Motor Oil (gal) Grease (lbs)

Diesel Fuel (gal)

Other: ____________

Contact Phone #:

Signature:

Name of company:

Person completing form:

Period covered: From: To:

Type of Material Total Diverted

Summary of Petroleum/Oil/Lubricant (POL) Diversion Negative Response Required

Antifreeze (gal)

Gas/Mogas (gal)

Sheet1

undefined:
Contact Phone:
Person completing form:
From:
To:
a Recycled tonsAsphalt:
a Recycled tonsConcrete:
a Recycled tonsDirt:
a Recycled tonsMetals:
a Recycled tonsWood Waste:
a Recycled tonsGreen Waste:
a Recycled tonsCorrugated Cardboard:
a Recycled tonsDeconstruction:
a Recycled tonsOther:
Other:

File details come from the government source that posted it. Updated .