KTR_Work_Surveillance_Checklist_-_ICS_Work.pdf

Contractor Work Surveillance Checklist

Industrial Cleaning Services (ICS) – CLINs 1002SV-1004SV & 1007SV-1009SV

Date(s) of Work Surveillance: _________________ Start Time: ___________ Stop Time: ___________

Name of Designated Government Representative: ___________________________________________

Title of Designated Government Representative: ____________________________________________

Phone Number of Designated Government Representative: (______) ________-___________

Yes No N/A Description of Contractor Work Surveillance

Did the work crew arrive on site at the scheduled time and date?

Did the crew arrive on site with all of the requisite equipment, including

- One standard vacuum truck (3,500-gal capacity) w/ 300 feet of hoses,

- One self-contained heated power washing unit,

- One liquid transfer pump w/ 300 feet of hoses, and

- All appropriate PPE and tools?

Did the vacuum truck driver provide a weight ticket showing the empty (tare) weight of the vacuum truck?

Was the vacuum truck inspected by a designated Government representative prior to use?

Did the vacuum truck arrive with a clean tank and hose fittings that were constructed of material that that was chemically compatible with the waste to be removed?

Did the vacuum truck arrive free of visible waste residue unless the truck was being used for multiple removals from the same project involving the same waste stream

(in which case it arrived as meeting definition of RCRA empty per 40 CFR 261.7)?

Did all of the equipment operate properly without causing delay in work?

Was the work performed to the satisfaction of the designated Government representative?

Comments:

Signature of Designated Government Representative Date