IFB_2200_CSH1059_ATT_8_v1.pdf

This is a Notice of Chemical Delivery form used by Austin Water (AW), a department of the City of Austin, Texas, for tracking and verifying the delivery of chemicals, specifically cationic polymer, used in potable water treatment. The form serves as a critical documentation tool that must be completed upon chemical delivery and submitted with payment materials to AW Accounts Payable. The form requires the chemical vendor to provide detailed information including the trucking company name, contact information, delivery date and time, chemical type, and destination. Additionally, the form mandates comprehensive truck and tanker identification details such as make, model, color, license plate number, and tank security seal number, along with driver and Commercial Driver's License (CDL) information, including the driver's name, CDL number and expiration date, and appropriate CDL endorsement codes (N for tanker vehicles, H for hazardous materials requiring placards, or X for combined tanker and hazardous materials operations).

The form includes verification requirements whereby AW staff must confirm that the submitted information matches actual delivery conditions and validate that the driver's CDL endorsement code is appropriate for the vehicle type and cargo being transported. The form explicitly requires that it be emailed to the delivery location site supervisor when the driver is dispatched for delivery to an Austin Water site. This document is essential for ensuring compliance with transportation regulations, maintaining chain-of-custody documentation for chemical deliveries, and supporting the City's procurement and accounts payable processes for the cationic polymer supply contract. The form was last revised on April 21, 2025.