Exhibits_A001_-_D001_CDRL_DD1423.pdf

EXHIBITS, A001, B001, C001, D001

MACROENCAPSULATION AND DISPOSAL OF MIXED WASTE

IN SUPPORT OF THE NAVAL NUCLEAR PROPULSION PROGRAM

PR # N4215881309100

Rev 2 (04/26/2018)

Contract Data Requirements List (CDRL) Table of Contents

ITEM SUBTITLE

A001 CERTIFICATE OF DISPOSAL/BURIAL

B001 RADIOLOGICAL SURVEY RESULTS

C001 ASBESTOS WASTE DOCUMENTATION

D001 COMPLETED WASTE SHIPPING DOCUMENTATION

Rev 2 (04/26/2018)

CONTRACT DATA REQUIREMENTS LIST

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The 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 the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the

Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

MACROENCAPSULATION AND DISPOSAL

E. CONTRACT/PR NO.

N4215881309100

F. CONTRACTOR

1. DATA ITEM NO

A001

2. TITLE OF DATA ITEM

CERTIFICATE OF DISPOSAL/BURIAL

3. SUBTITLE

CERTIFICATE OF DISPOSAL/BURIAL

4. AUTHORITY (Data Acquisition Doc. No)

OT-18-20100

5. CONTRACT REFERENCE

PWS, PARA, 3.6.1

6. REQUIRING OFFICE

NNSY Code 106.4 (LSMM)

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

ASREQ

(See BLK 16)

12. DATE OF FIRST SUBMISSION

ASREQ

(See BLK 16)

14. DISTRIBUTION

See BLK 16

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

(See BLK 16)

ADDRESSEES

Draft

Final

Reg Repro

16. REMARKS

BLK 9: Distribution Statement “A”. Approved for public release; distribution unlimited.

BLKs 10, 12, 13: The certificate of Disposal/Burial shall be provided within ten (10) days of disposal/burial date.

BLK 14: Distribution shall be to the Contracting Officer’s Representative (COR) and the NNPP Site Technical Personnel as set forth in each individual task order.

Distribution shall be via fax, hard copy, or by electronic method, as directed by the

Government

POC(s):

NNSY C106.4 COR: Kristin Corrie, 757-396-2432, kristin.corrie@navy.mil

NNPP Site Representative

NNSY

C106.4 COR

NNPP Site 1

15. TOTAL 2

G. PREPARED BY

Kristin Corrie

H. DATE 31 July 18 I. APPROVED BY

Michael L Jones

J. DATE 31 July 18

17. PRICE

GROUP

18. ESTIMATED

TOTAL PRICE

DATA ITEM DESCRIPTION

Title: CERTIFICATE OF DISPOSAL/BURIAL

Number: OT-18-20100 Approval Date: 20180530

AMSC Number: N/A Limitation: N4215881309100

DTIC Applicable: No GIDEP Applicable: No

Office of Primary Responsibility: SH

Applicable Forms: N/A Project No.: N/A

Use/Relationship: The certificate of disposal/burial will provide the Government with information pertaining to the permanent treatment/disposal of waste at a licensed disposal facility.

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

This DID is for one-time use for solicitation N4215881309100

Requirements:

1. Format. The certificate of disposal/burial shall be in the contractor’s format.

2. Content. The certificate of disposal/burial from the licensed disposal facility shall contain the following at a minimum:

a) Volume (in cubic feet) of each container/item disposed

b) Date the waste was disposed

c) Shipping manifest number and the Naval Nuclear Propulsion

Program generator name(s) and manifest number(s) under which the waste (or material) was originally received

d) The location or pit where each container/item is placed at the disposal facility (as applicable).

End of OT-18-20100.

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The 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 the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the

Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

B

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

MACROENCAPSULATION AND DISPOSAL

E. CONTRACT/PR NO.

N4215881309100

F. CONTRACTOR

1. DATA ITEM NO

B001

2. TITLE OF DATA ITEM

RADIOLOGICAL SURVEY RESULTS

3. SUBTITLE

RADIOLOGICAL SURVEY RESULTS

4. AUTHORITY (Data Acquisition Doc. No)

OT-18-20101

5. CONTRACT REFERENCE

PWS, PARA, 3.6.2

6. REQUIRING OFFICE

NNSY Code 106.4 (LSMM)

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

B

10. FREQUENCY

ASREQ

(See BLK 16)

12. DATE OF FIRST SUBMISSION

ASREQ

(See BLK 16)

14. DISTRIBUTION

See BLK 16

8. APP CODE

N/A

11. AS OF DATE

See BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

(See BLK 16)

ADDRESSEES

Draft

Final

Reg Repro

16. REMARKS

BLK 9: Distribution B. Distribution authorized to U.S. Government Agencies (For

Official Use Only) (08 February 2018). Other requests for this document shall be referred to Lead Shipyard for Mixed Material, Code 106.4, Bldg. M22-3 Room 317, Norfolk Naval Shipyard, Portsmouth, VA, 23709-1035.

BLKs 10, 11, 12, 13: Radiological survey results shall be provided upon request by either the Contracting Officer's Representative (COR) or the Naval Nuclear Propulsion

Program (NNPP) Site Technical Personnel.

BLK 14: Distribution shall be to the COR and the NNPP Site Technical Personnel as set forth in each individual task order. Distribution shall be via fax, hard copy, or by electronic method, as directed by the Government.

POC(s):

NNSY C106.4 COR: Kristin Corrie, 757-396-2432, kristin.corrie@navy.mil

NNPP Site Representative

NNSY

C106.4 COR

NNPP Site 1

15. TOTAL 2

G. PREPARED BY

Kristin Corrie

H. DATE

I. APPROVED BY

Michael L Jones

J. DATE

17. PRICE

GROUP

18. ESTIMATED

mailto:kristin.corrie@navy.mil

Title: RADIOLOGICAL SURVEY RESULTS

Number: OT-18-20101 Approval Date: 20180530

AMSC Number: N/A Limitation: N4215881309100

DTIC Applicable: No GIDEP Applicable: No

Use/Relationship: Radiological survey results will provide the

Government with verification of compliance with conditions and limits on the generator’s waste sent for shipment and disposal.

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

This DID is for one-time use for solicitation N4215881309100

Requirements:

3. Format. The radiological survey results shall be in the contractor’s format.

4. Content. The radiological survey results shall contain:

a) Verification of compliance with radiological conditions and limits set forth in the contract Performance Work

Statement.

b) Radiological survey techniques.

End of OT-18-20101.

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The 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 the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the

C

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

MACROENCAPSULATION AND DISPOSAL

E. CONTRACT/PR NO.

C001

2. TITLE OF DATA ITEM

ASBESTOS WASTE DOCUMENTATION

3. SUBTITLE

ASBESTOS WASTE DOCUMENTATION

4. AUTHORITY (Data Acquisition Doc. No)

OT-18-20102

5. CONTRACT REFERENCE

PWS, PARA, 3.6.3

6. REQUIRING OFFICE

NNSY Code 106.4 (LSMM)

7. DD 250 REQ

N/A

A

ASREQ

(See BLK 16)

12. DATE OF FIRST SUBMISSION

ASREQ

(See BLK 16)

14. DISTRIBUTION

See BLK 16

8. APP CODE

SUBMISSION

ASREQ

(See BLK 16)

ADDRESSEES

Draft

Final

Reg Repro

16. REMARKS

BLK 9: Distribution Statement “A”. Approved for public release; distribution unlimited.

BLKs 10, 12, 13: Copies of all signed waste shipment manifests and records shall be provided within ten (10) days of shipment receipt at the disposal facility. A signed

Certificate of Disposal (COD) shall also be provided within ten (10) days of burial of such asbestos waste and any asbestos containing daughter waste products.

BLK 14: Distribution shall be to the Contracting Officer's Representative (COR) and the

Naval Nuclear Propulsion Program (NNPP) Site Technical Personnel as set forth in each individual task order. Distribution shall be via fax, hard copy, or by electronic method, as directed by the Government.

NNPP Site Representative

NNSY

C106.4 COR

H. DATE 31 July 18

J. DATE 31 July 18

18. ESTIMATED

Title: ASBESTOS WASTE DOCUMENTATION

Number: OT-18-20102 Approval Date: 20180530

AMSC Number: N/A Limitation: N4215881309100

DTIC Applicable: No GIDEP Applicable: No

Use/Relationship: Asbestos waste and any asbestos containing daughter waste products originating from asbestos waste, generated within the State of South Carolina shall be tracked until disposed. Waste shipment records will provide the

Government with tracking, shipping, and disposal information on the Government generator’s asbestos waste.

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

This DID is for one-time use for solicitation N4215881309100

Requirements:

1. Format. The applicable waste shipment records shall be in the contractor’s format.

2. Content. All asbestos containing products generated within the State of South Carolina are assigned an asbestos abatement Project ID number by the Department of Health and

Environmental Control. The ID number typically begins with an “R” followed by seven digits. The contractor shall include the Project ID number on all copies of the applicable waste shipment record(s) (as required in 40 CFR

61.150) accompanying asbestos waste and any asbestos containing daughter waste products resulting from processing/disposal of asbestos wastes generated within the

State of South Carolina.

End of OT-18-20102.

(1 DATA ITEM)

Form Approved

OMB No. 0704-0188

The 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 the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the

D

C. CATEGORY

TDP TM OTHER X 1

D. SYSTEM/ITEM

MACROENCAPSULATION AND DISPOSAL

E. CONTRACT/PR NO.

D001

2. TITLE OF DATA ITEM

COMPLETED WASTE SHIPPING DOCUMENTATION

3. SUBTITLE

COMPLETED WASTE SHIPPING

DOCUMENTATION

4. AUTHORITY (Data Acquisition Doc. No)

OT-18-20103

5. CONTRACT REFERENCE

PWS, PARA, 3.6.4

6. REQUIRING OFFICE

NNSY Code 106.4 (LSMM

7. DD 250 REQ

N/A

A

ASGEN

(See BLK 16)

12. DATE OF FIRST SUBMISSION

ASGEN

(See BLK 16)

14. DISTRIBUTION

See BLK 16

8. APP CODE

SUBMISSION

ASGEN

(See BLK 16)

ADDRESSEES

Draft

Final

Reg Repro

16. REMARKS

BLK 9: Distribution Statement “A”. Approved for public release; distribution unlimited.

BLKs 10, 12, 13: Copies of signed manifests shall be provided within ten (10) days of receipt at the disposal facility.

BLK 14: Distribution shall be to the Contracting Officer's Representative (COR) and the

Naval Nuclear Propulsion Program (NNPP) site technical personnel as set forth in each individual task order. Distribution shall be via fax, hard copy, or by electronic method, as directed by the Government.

NNPP Site Representative

NNSY

C106.4 COR

H. DATE 31 July 18

J. DATE 31 July 18

18. ESTIMATED

Title: COMPLETED WASTE SHIPPING DOCUMENTATION

Number: OT-18-20103 Approval Date: 20180530

AMSC Number: N/A Limitation: N4215881309100

DTIC Applicable: No GIDEP Applicable: No

Use/Relationship: The signed completed waste shipping documentation utilized for the shipment of waste to the contractor’s treatment/disposal facility will provide the government with waste tracking and receipt information to the generating site and applicable State (i.e., CA, ME, PA, NY, etc.

as required).

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

This DID is for one-time use for solicitation N4215881309100.

Requirements:

5. Format. The completed waste shipping documentation shall be in the contractor’s format.

6. Content. The signed completed waste shipping documentation for the transportation of the waste material to the disposal facility shall contain the following:

a) The signed Uniform Low-Level Radioactive Waste Manifest

b) The completed signed Uniform Hazardous Waste Manifest

b) The signed Asbestos Waste Shipment Record (as applicable)

c) Any other applicable signed waste shipping documents, upon request.

End of OT-18-20103.