Exhibit_O_26-8705_Delivery_Checklist.pdf
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- Attached to
- Countywide Chemicals
- Solicitation number
- 26-8705
- Issued by
- Collier County, Florida
About this file
This is a Chemical Hazardous Material Delivery Checklist document associated with Collier County's Countywide Chemicals procurement opportunity in Florida. The checklist is a mandatory inspection and verification form that the assigned plant operator must complete for each chemical delivery, using a separate checklist per chemical delivery. The document is designed to be maintained with delivery manifests and retained in the vendor's file for a minimum of five years. The checklist captures essential information including the chemical vendor name, the specific chemical being delivered, delivery driver name and driver's license number, plant operator name, and precise delivery timing (arrival and departure times with dates). The form addresses three critical inspection phases: driver safety and security verification, pre-offload inspection, and post-offload inspection, with each section containing specific checkpoints that must be marked as yes, no, or not applicable.
The pre-offload inspection verifies that the delivery driver has acknowledged plant emergency evacuation procedures, the offload location and tank are free from chemical releases or spills, piping and connections are undamaged, containment areas are free from excessive water or debris that could cause overflow, and tank levels are sufficiently low to accept the delivery. The post-offload inspection confirms the same conditions following delivery and verifies that the tank is not overfilled, with actual tank levels recorded before and after delivery. The checklist specifically references four one-ton chlorine cylinders as an example delivery quantity and requires both the plant operator and delivery driver to sign the form, certifying that the chemical delivery meets all requirements of Collier County's Vendor Chemical Delivery Program.
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Text version
Countywide Chemicals
CHEMICAL HAZARDOUS MATERIAL
DELIVERY CHECKLIST
The assigned plant operator shall use this checklist for each chemical delivery. The checklist shall be completed in detail and accompany the delivery manifest(s) and be maintained within the specific vendor’s file for a period of no less than 5 years. Use a separate checklist for each chemical delivered.
CHEMICAL VENDOR NAME (PRINTED):
CHEMICAL BEING DELIVERED:
DELIVERY DRIVER NAME (PRINTED): DL LICENSE #:
PLANT OPERATOR NAME (PRINTED):
DATE OF DELIVERY: ____ /____ /____
ARRIVAL TIME: ____:_____ AM / PM
DEPARTURE TIME: ____:____ AM /
PM
DELIVERY DRIVER SAFETY / SECURITY VERIFICATION YES NO N/A
Printed Name Legible Valid Driver’s License Driver matches license picture to the best of operators’ knowledge Proof of driver training provided for chemical being delivered
PRE – OFFLOAD INSPECTION
YES NO N/A
Delivery driver informed of and acknowledged plant emergency evacuation procedures and meeting location Offload location or tank free from any chemical releases and/or spills Offload pipe valves/connects/disconnects free from any visible damage Any other visible damage that would interfere with delivery of chemical Tank/location containment free from excessive water accumulation and/or any other material or debris that would cause an overflow of the containment should a release occur
Tank level within acceptable limits for new delivery (low enough to accept delivery) Actual tank level (Ex. 500 Gallons)
POST – OFFLOAD INSPECTION YES NO N/A
Offload tank or location free from any chemical releases and/or spills Offload piping/valves/ connects/disconnects free from any visible damage caused during delivery Any other visible damage that would interfere with delivery of chemical Tank level within acceptable limits after delivery (not overfilled) Actual tank level (Ex. 1000 Gallons) Amount Delivered (4 –One Ton Chlorine Cylinders)
Notes:
THE OPERATOR AND DELIVERY DRIVER LISTED ABOVE AND BELOW HAVE DEEMED THAT THIS CHEMICAL DELIVERY MEETS ALL REQUIREMENTS OF COLLIER COUNTY’S VENDOR CHEMICAL DELIVERY PROGRAM REQUIREMENTS.
PLANT OPERATOR (SIGNATURE ABOVE)
DELIVERY DRIVER (SIGNATURE ABOVE)
File details come from the government source that posted it. Updated .