9a)_FA8903-16-Q-0008_-_Exhibit_A.PDF

(COMPUTER GENERATED)

CONTRACT DATA REQUIREMENTS LIST

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0002 A MGMT

RCRA PART II PERMIT RENEWAL FA8903-16-Q-0008 TBD

A001 REPORT, PRODUCTION OR DELIVERY PROBLEM(S) N/A

DI-MGMT-81178 PWS PARA - 3.4.1 AFCEC/CZRX

LT

N/A B

ASREQ

ARTHUR HATFIELD, AFCEC/CZRX3/7/2016DAVID HOLGUIN

N/A

3/7/2016

AFCEC/CZRX 0 0 1

772 ESS/PKS 0 0 1

BASE POC 0 0 1

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16BLOCK 16

0 0 3

Block 4: DID TAILORING: Delete para 7.2 Para 10.2.1a Delete reference to system/component, hull tasks.

Block 12: The contractor shall immediately report to the Base POC, CO & COR, by telephone or e-mail, any potential health risks. The contractor shall submit a written notice within three (3) business days of telephonic notification.

Block 14: All deliverables shall be submitted by e-mail or on CD-ROM, as necessary. The government uses Microsoft Office Suite. E-mail addresses shall be provided by the COR.

1 1

FOR OFFICIAL USE ONLY

FA8903-16-Q-0008

Exhibit: A

1241956829C Typewritten Text

1241956829C Typewritten Text

1241956829C Typewritten Text Attchment 9a

1241956829C Typewritten Text

DATA ITEM DESCRIPTION OMO NO. o w l m

2. mu - t 1. IDENTIFIUTION NUMBER

REPORT, PRODUCTION OR DELIVERY PROBLEM(s) DI-UGUT- 81 178

I 3.1 The report is used to inform the procuring activity of crises which have developed, or are developing, and which have the potential to stop, interrupt or severely impact the production or delivery of contract end items.

I 7.2 This DID is applicable to the acquisition, of both hardware and softvare systems, subsystems, components and equipment. It may be applied to any contract covering the acquisition of arpplies/services, the delive'ky of vhich, if stopped I

(continued on page 2) -

I (continued on page 2) I

4. WPROVAL DATE

WMMOO)

910328

J

WPROVAL U M K A T O N )b. AM% NUMBER

86094

1 10.1 Fonat. The report shall be in contractor forut. I

7 . 4PPUCATK)N I INTERREUTIONSMIP

7.1 This data item description (DID) contains the format'md content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

I 10.2 Content. The report shall contain the folloving: I

6b. GIDEP REOUIRED 5. OFFICE OF PRIMARY RESPONSIBILITY (OPR)

N/SEA 06D32

1 10.2.1 Identification. The first page of the iceport shall contain the follaving: I

6a. OTlC REQUIRED

a. Identification of the ~stem/component/progrum/project/hull/activity involved.

b. Contract Number.

c. Preparing activity.

d. ~erial/identification number (assigned by the preparing activity), and the date.

e. Security classification, when required.

10.2.2 Body of Report. The report shall contain a complete, but concise, explanation as to the nature and cause of the crisis or problem and the current or potential impact on contract end item production, delivery, cost or scheduling.

In addition, the report shall include the folloving as applicable and appropriate:

I (continued on page 2) I DIS1RlBUTK)N STATEMENT I

Distribution Statement A: Approved for public release; distribution is limited.

L DO Form 1664. JUN a m * o y ~ d o o I--(. ~ u ; r or 2 PAGES

./PI 0102- '-0014641

88 -*I l-I.C.(.CIP I..* .a,. ,"*.,4.a:p

FA8903-16-Q-0008

Exhibit: A

Block 3, DESCRIPTION/PURPOSE (continued)

3.2 Examples of such crises are: accidents, strikes, subcontractor or vendor difficulties or slippage, shortage of material, transportation tie-ups, or other potential bottlenecks vhich may impact contract end item production or delivery.

Block 7, APPLICATION/INTERRELATIONSRIP (continued) or interrupted, vill adversely.effect a military program, project or operation, or the construction, conversion, overhaul, alteration or maintenance of military ships, systems or equipment.

Block 10, PREPARATION INSTRUCTIONS (continued)

a. Action(s1 Taken. Describe contractor action(s) taken to remedy the crisis or problem. If no contractor action-has been taken, provide a brief explanation.

b. Action(s1 Required. Clearly indicate the action(s) required, the date by which the action is required, and the responsible party, e.g., contractor, procuring activity, other agency or activity.

c. Revised Data. Revised/updated production, delivery, cost or scheduling data should be provided, if available.

d. Contractor Recommendations. Delineate contractor recotmendation(s), if any, to solve the current crisis or problem, to prevent a recurrence, or for procuring activity follorup.

e. Appendices. Tables, references, charts or other descriptive material or information that will clarify the crisis or problem, or that will support the rationale for contractor recommendations, if any, should be provided as appendices. Each appendix ahall be identified and referenced in the appropriate area of the report.

10.2.3 Report Preparer. Name and telephone number of the person(8) preparing the report.

page 2 of 2 pages

FA8903-16-Q-0008

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0002 A MISC

RCRA PART II PERMIT RENEWAL FA8903-16-Q-0008 TBD

A002 SCIENTIFIC AND TECHNICAL REPORTS ORGANIZATIONAL CHART

DI-MISC-80711A PWS PARA - 3.4.2 AFCEC/CZRX

LT

N/A B

ASREQ

ARTHUR HATFIELD, AFCEC/CZRX3/7/2016DAVID HOLGUIN

N/A

3/7/2016

AFCEC/CZRX 0 0 1

BASE POC 0 0 1

772 ESS/PKS 0 0 1

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16N/A

0 0 3

Blocks 12, & 13 : Not later than 14 business days after award of the task order. Subsequent submissions shall be upon any changes to key personnel and shall be submitted within 3 business days of the changes.

Block 14: All deliverables shall be submitted by e-mail or on CD-ROM, as necessary. The government uses Microsoft Office Suite. E-mail addresses will be provided by the COR.

1 1

FOR OFFICIAL USE ONLY

FA8903-16-Q-0008

FA8903-16-Q-0008

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0002 A MISC

RCRA PART II PERMIT RENEWAL FA8903-16-Q-0008 TBD

A003 SCIENTIFIC AND TECHNICAL REPORTS OSHA REPORT

DI-MISC-80711A PWS PARA - 3.5.1 AFCEC/CZRX

LT

N/A B

ASREQ

ARTHUR HATFIELD, AFCEC/CZRX3/7/2016DAVID HOLGUIN

N/A

3/7/2016

AFCEC/CZRX 0 0 1

772 ESS/PKS 0 0 1

BASE POC 0 0 1

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16N/A

0 0 3

Blocks 12, & 13 : Submit to government within 5 business days of submittal to OSHA.

Block 14: All deliverables shall be submitted by e-mail or on CD-ROM, as necessary. The government uses Microsoft Office Suite. E-mail addresses will be provided by the COR.

1 1

FOR OFFICIAL USE ONLY

FA8903-16-Q-0008

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0002 A MGMT

RCRA PART II PERMIT RENEWAL FA8903-16-Q-0008 TBD

A004 TECHNICAL AND MANAGEMENT WORK PLAN WORK PLAN

DI-MGMT-81117 PWS PARA - 4.9 AFCEC/CZRX

LT

A B

ONE/R

ARTHUR HATFIELD, AFCEC/CZRX3/7/2016DAVID HOLGUIN

N/A

3/7/2016

AFCEC/CZRX 1 1 1

BASE POC 1 1 1

772 ESS/PKS 0 0 LT

SEE BLOCK 16

NSP

BLOCK 16

N/AN/A

2 2 2

Block 12: Draft plan shall be submitted within 30 business days of task order award. The government shall require up to 30 business days for review of draft. The contractor shall incorporate government comments and submit final within 15 business days of receipt of government comments/approval.

Block 14: All deliverables shall be submitted by e-mail or on CD-ROM, as necessary. The government uses Microsoft Office Suite. E-mail addresses will be provided by the COR.

1 1

FOR OFFICIAL USE ONLY

FA8903-16-Q-0008

DATA ITEM DESCRIPTION .

7 . 2 This DID may be used on any contract which is delivery order oriented.

Form P l E r n * d OYI ~a 0 7 w r u 8

I. APPROVAL wc Cvr-I

901219

10.1.1 -. Tha plan shall identify the contractor@s m e contract number, t i t l e and number of #e delivery or task ,order, security classification of the plan, name o f contract uonitor, an8 t h e Government office irauing the: tasking. .

, n u

TECHNICAL AND W A G E H E N T WORK PLAN

- '. U F W A T K ) n : W T E R 4 U 1 ~

7.1 his Data Item Description (DID) contains the format and content preparation instructions for the data product generated by the specifi and discrete task requirement as delineated in the contract.

s. c ;WE OF mm*rrr asmwmrun mm

X0.1.2 -material. The plan shall include descriptive matariaX, isyetem diagrams, sNtchee, photographs, tablea, forms, graphs, worksheets, char-, drawings, eto., a6 required. l0.r -. The plan shall be typewritten or printed on 8 1/2 11 ch paper. The pages &all be sequentially numbered and securely bound together. As nrceooary, graphic material may be one-way foldouts. A l 1 attachment6 shall be identified and referenced in khe text. Each sectfon and paragraph 8hall be numbered.

10.1.4 Tablg. plans of more than 30 pagea in

length shall contain a table of conkmts.

I. IDWWIUTON N U H ~ E ~

Dl-Mm-81117

9k *rrK NUlJlu

A6003

L UM0u.L UMlTAWM

( ~ o n t h u e d on Page :

1. DLSaiPrKIMlhlRmLE

3,1 The Technical and Hanagement Work Plan describes the contractor's plan to implement.the Statement of Work (SOW) tasking provided via delivery order or tasl order.

4#. OX UIUL~BLC

la rwutam wgtlstrnosa

10.1 -. The plan shall be subm%tted in a contractor devised and Government approved format w h i c h conforass to the following:

hu.rrPuwcrHIIIM5

I I . OtLlWuMW RATSMEW

DISTRIBUTION STATEMZNT A: approved for public release; distribution j unl hi ted .

WWDCC ACCUCAUE

FA8903-16-Q-0008

Block lo, preparation Instructions (Continued)

10.1.5 s e a i b i l a . The document s h a l l be legible and reproducible.

10.2 C ~ n t e n t . The plan shall include information necessary to substantiate the-.contractor's approach t o completing the delivery or task order and information necessary f o r the Government to assess the soundness Of the contractor's approach. The plan shall contain the following:

10.2.1 -at- structw. The plan sha l l include a d e ~ c r i p t i a n of the contractor8s organizational structure and assignment of functions, duties, and respons ib i l i t i es which vill be assigned i n Support of the tasking. Additionally, the plan s h a l l ident i fy the contractorrs procedures, policies, and raport5ng requirements established t o i n i t i a t e , monitor, control, complete, and report on a c t i v i t i e s required of the delivery or tack order.

10 .2 .2 m a t f o t l a l interfaces. The plan sha l l describe a l l interfaces between the contrackor and the Government and between the contractor and other contractors or subcontractors which are necessary to complete the asmigned tasking. This shall include a descr ipt ion Of the applicable respons ib i l i t i es and functional re la t ionships betveen those organizations.

10.7 .3 pethod01 . The plan s h a l l include a narra t ive descr ipt ioh c lear ly d e f i n i n g z e t a c h n i a l approach (or method) Including toole, standards, and procedures to be wed by the contractor t o accomplish the delivery or task order, All d-antation, ac t iv i ty , or decisions required from the Government or ather GaverrrsPent contractor shall ha identified.

10.2.4 perso-. .The plan s h a l l identify the nmas and types of persome1 assigned to acconrpliah the delivary or.'LPsk order, .The plan shall show how the conbination of people assigned t o each task provides a su f f i c i en t knowledge or' experience base for that task. This includolu identifying any spec ia l education, training, experience, or skilla of these individwlci. Also, any spacial a&d.nistrative support requlrwnents oha l l be ident i f ied.

10.2.5 Securitu. The plan ohall identify any special or unique secur i ty requirements resulting from the delivery o r task order.

10,Z.L Sched . me plan ~bl l include a milastone chart(8) graphically d 3 c t i n g the schedule of eveintc aseooiateid with tbe delivery or task order, 'l!b lwel of d e t a i l s h a l l be eufficient to clearly show h w each eubtaok shall be pcrfozmod. his inoludee:

Page 2 of 3 Pages

FA8903-16-Q-0008

Block lo, Preparation Instructions (Continued)

a. contractor activities.

b. Contractor deliverances (interim and final], including briefings (if required).

c, Other program milestones as appropriate (including Government input in 10.2.3 above).

dm Periodic milestones to allow adequate Government review of contractor progress.

10.2 7 The plan shall include a resources chart that graphically and numerically identifies the contractor's total planned manhour level of effort (WE) and LoE by month for each subtask identified in the delivery or task order. Proposed monthly aubtask manhour6 mhall be br~ken out by labar m ate gory in support of the dolivery or task order.

10.2.8 a The plan shall include a list of the travel requirements that shall include the following for each trip:

a. Company ar Govemnmt agency visited.

b. Location.

c, Number of travellers by labar category.

Trip dust ion.

10.2,9 contract= reauested data. Tbe plan shall include the contractor's best assessment of any additional data required by the contractor. This liet shall be as detailed as-poaarible and shall include document titles, respansible Government organizatione, anB reeponsjble Gavernment contractors. The criticality of each data required ahall be identified.

1D.2.10 Pelfverables. The plan shall include a brief description of the content8 of eacb deliverable to be provided as a result af the delivery or task order.

Page 3 of 3 Pages

FA8903-16-Q-0008

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0002 A QCIC

RCRA PART II PERMIT RENEWAL FA8903-16-Q-0008 TBD

A005 QUALITY SYSTEM PLAN QUALITY CONTROL PLAN

DI-QCIC-81449 PWS PARA - 4.10 AFCEC/CZRX

LT

A A

ONE/R

ARTHUR HATFIELD, AFCEC/CZRX3/7/2016DAVID HOLGUIN

N/A

3/7/2016

AFCEC/CZRX 1 1 1

772 ESS/PKS 0 0 LT

BASE POC 1 1 1

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16N/A

2 2 2

Block 12: Draft plan shall be submitted within 30 business days of task order award. The government shall require up to 30 business days for review of draft. The contractor shall incorporate government comments and submit final within 15 business days of receipt of government comments/approval.

Block 14: All deliverables shall be submitted by e-mail or on CD-ROM, as necessary. The government uses Microsoft Office Suite. E-mail addresses will be provided by the COR.

1 1

FOR OFFICIAL USE ONLY

FA8903-16-Q-0008

Source: https://assist.dla.mil -- Downloaded: 2015-05-08T19:25Z Check the source to verify that this is the current version before use.

FA8903-16-Q-0008

FA8903-16-Q-0008

FA8903-16-Q-0008

FA8903-16-Q-0008

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 this burden, to Department of Defense, Washington Headquarters Services, Directorate forInformation Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

(1 Data Item) Form Approved OMB No. 0704-0188

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT 10. FREQUENCY

11. AS OF DATE

12.DATE OF FIRST SUBMISSION

13.DATE OF SUBSEQUENT

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE GROUP 18. ESTIMATED TOTAL PRICE

DD Form 1423-1, JUN 90 PREVIOUS EDITIONS ARE OBSOLETE Page of Pages USAPPC V3.00

REQUIRED

SUBMISSION

0002 A MISC

RCRA PART II PERMIT RENEWAL FA8903-16-Q-0008 TBD

A006 SCIENTIFIC AND TECHNICAL REPORTS RCRA PART II PERMIT RENEWAL

DI-MISC-80711A PWS PARA - 5.2 AFCEC/CZRX

LT

A B

ONE/R

ARTHUR HATFIELD, AFCEC/CZRX3/7/2016DAVID HOLGUIN

N/A

3/7/2016

AFCEC/CZRX 1 1 1

772 ESS/PKS 0 0 LT

BASE POC 1 1 1

** KDHE ** 0 1 1

SEE BLOCK 16

NSP

BLOCK 16

BLOCK 16N/A

2 3 3

Block 4: DID Tailoring: DID Block 6a is not applicable.

Block 12: Submit draft documentation in accordance with the approved Project Schedule. The government shall require up to 30 business days for review of draft. The contractor shall incorporate government comments and submit final to KDHE for review/approval within 15 business days of receipt of goverment comments/approval.

Block 14: All deliverables to AFCEC shall be submitted by e-mail or on CD-ROM, as necessary, hard copy and electronic to 22 CES. The government uses Microsoft Office Suite. E-mail addresses will be provided by the COR.

NOTE:

** KDHE = Kansas Department of Health and Environment.

1 1

FOR OFFICIAL USE ONLY

FA8903-16-Q-0008