Attachment 10 DLA Form 2505.docx
DLA Form DOCX document 14 KB Posted
- Solicitation number
- SP450021R0003
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Defense Logistics Agency
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| Agency | Files |
|---|---|
| Defense Logistics Agency | 43 |
| Defense Logistics Agency Disposition Services | 13 |
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Text version
MANIFEST TRACKING LOG
Prescribed by: DRMS-I 4160 Sponsor: Disposition
| COMPANY NAME |
| CONTRACT # |
| TO # |
| INVOICE AMOUNT ($) |
| DATE |
CHECK ONE
(If this is not exclusively Phase I Submittal)
This is my initial submission and it includes complete Phase I and Phase II data
I previously submitted Phase I data and am now submitting Phase II data I CERTIFY TO THE BEST OF MY KNOWLEDGE THAT THIS CONTRACT PERFORMANCE SUPPORTING DATA IS ACCURATE, COMPLETE AND MEETS ALL REQUIREMENTS SET FORTH IN THE CONTRACT
| NAME |
| SIGNATURE |
| 1. |
| 2. |
| 3. |
| 4. |
| 5. |
| 6. |
| 7. |
| 8. |
| 9. |
| 10. |
| 11. |
| 12. |
| 13. |
| 14. |
Line Item #
Doc #
HIN #
P/U Mnfst #
P/U Qty
Initial TSDF Receipt Date (DD/MMM/YY)
Initial TSDF MMC
Interim/Disp Manifest #
Mnfst Pg/Li
CTN
No & Type
Interim/Disposal Facility EPA ID #
Interim/ Disposal MMC
QTY
Disp.
TSDF Accept Date/PCB Date
(DD/MMM/YY)
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DLA FORM 2505, OCT 2013
PDF (DLA)
| MANIFEST TRACKING LOG |
| Prescribed by: DRMS-I 4160 Sponsor: Disposition |
INSTRUCTIONS
NOTE: For special service items, complete only blocks 1, 2, 3, 5 and 6.
| Column 1: | Line Item # - line item number for the item being disposed. (Four digits - e.g.: 0001) | |
| Column 2: | Document # - Document number as it appears on the DD Form 1155 (External PR). (Eight digits - e.g.: 1236ABCD) Column 3: | HIN # - HIN number as it appears on DD Form 1155 (Six characters - e.g.: 9404NC) |
| Column 4: | Pickup (P/U) Mnfst. # - Manifest document number assigned to each manifest or shipping paper used to ship the waste to the initial TSDF (5 or 12 characters - e.g.: 02034; 123456789GBF) |
Column 5: Picked Up (P/U) QTY - actual quantity picked up. For special service items, insert actual quantity completed.
| Column 6: | Initial TSDF Receipt Date - Actual date listed on the shipping paper next to the signature of the representative of the first TSDF accepting the shipment (dd/mmm/yy). For special service items, insert final date all services were completed. |
| Column 7: | Initial TSDF MMC - List the appropriate waste Management Method Code used by the first TSDF for treatment, storage, and/or disposal methods (40 CFR 264, Appendix 1, Table 2 no longer applies) |
| Column 8: | Interim/ Disposal Manifest # - Manifest document number assigned to each manifest or shipping paper used to ship all, or parts of the waste to other TSDFs, including all interims and finals, after receipt at initial TSDF. EXCEPTION: If final treatment and/or disposal is accomplished by the initial TSDF, insert "Same as # 4" and do not fill out blocks 9 thru 14. (PCBs will require block 14 entry) |
| Column 9: | Manifest Page/Line- Identify the page and manifest line number that the document number has been placed on from manifest block 9a, 27a, etc…. Column 10: | Containers (CTN) No & Type – Identify the number of containers and type of containers from block 10, 28, etc…. |
| Column 11: | Interim/Disposal Facility EPA# - EPA Identification number (or DLA Disposition Services "dummy" number) assigned to each and every facility involved in the treatment, storage, and final disposal. (As defined in section C of the contract) of the item. Use additional lines as necessary. (Twelve digits - e.g.: PAD 456123912) NOTE: If final disposal did not occur at the initial facility, then the initial facility is considered an interim facility for Phase II tracking purposes. In those instances, the initial facility's EPA ID number should be included in Block 11 when Phase II information is submitted. |
Column 12: Interim/Disposal MMC Codes - List the appropriate Management method code(s) listed at 40 CFR 264, Appendix 1, Table 2-not applicable, performed by any interim and final disposal facilities. Note: Include any treatment and/or handling performed at initial TSDF, which was NOT identified in Phase I.
Column 13: Qty Disposed - Actual quantity of item disposed.
Column 14: Interim/Disposal TSDF Accept Date and Disposal Date (PCBs Only) - Actual date listed on the shipping paper next to the signature of the representative of each and every interim and final TSDF's accepting, treating, and/or disposing of the waste (dd/mmm/yy). - Date of actual final disposal of PCB item (dd/mmm/yy).
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