Exhibit 4 Example- Army Recycling Program Summary of Petroleum Oil Lubricant (POL) Diversion.pdf

This is a Summary of Petroleum/Oil/Lubricant (POL) Diversion reporting form for the U.S. Army's DPW (Directorate of Public Works) Recycling Program, revised as of January 1, 2026. The form requires monthly submission to kimberly.m.welch14.civ@army.mil and must include the completed summary form, copies of daily logs, and a copy of the monthly POL Request Log. A negative response is required if no materials were diverted.

The form tracks the following material categories diverted during the reporting period: Antifreeze (gallons), JP-8 (gallons), Oily Water (gallons), Used Motor Oil (gallons), Grease (pounds), Gas/Mogas (gallons), Diesel Fuel (gallons), and Other materials. The example provided shows diversion data for POL Services from February 1–28, 2026, documenting 392 gallons of antifreeze, 961 gallons of JP-8, 3,247 gallons of used motor oil, and 52 pounds of grease, with zero quantities recorded for oily water, gas/mogas, and diesel fuel. The form requires completion by company personnel, including the company name, person completing the form, contact phone number, and authorized signature.