Attachment_3_-_1683E _Amendment_1.pdf

SP4520-14-R-0003 Attachment 3

I CERTIFY THAT THIS CONTRACT PERFORMANCE DATA IS DATE PREPARED: CONTRACT NUMBER

MANIFEST ACCURATE, COMPLETE AND MEETS ALL REQUIRMENTS SP4520-XX-D-XXXX

TRACKING SET FORTH IN THE CONTRACT D.O.

LOG NAME (Print) SIGNATURE

1. Line # 2. BOSS Doc.

No.

3. CLIN # 4. Pickup Manifest

No.(s)

5. Quantity Removed

(KGs)

6. Initial (Temporary)

Storage Facility BOSS

ID #

7. Initial (Temporary)

Storage Facility Handling Codes

8. EWC

Codes

9. Final TSDF Disposal

Manifest #

10. Final TSDF Facility

BOSS ID #

11. Qty Disposed

(KGs)

12. Final TSDF Disposal

Handling Codes

13. Final TSDF Acceptance Date

(dd-mm-yyyy)

DRMS FORM 1683e, JAN 00 (MH)

RFP SP4520-12-R-0029, Attachment 3

INSTRUCTIONS FOR ATTACHMENT 3

Col 1. List the Delivery Order Line Number for the items being disposed (four (4) digits - i.e., 0001)

Col 2. List the BOSS document number as it appears on the DD Form 1155 (eight (8) digits - 12383976)

Col 3. CLIN Number - (N26000)

Col 4. List all pickup manifiest numbers (last five digits)

Col 5 Total kgs picked up

Col 6. List the BOSS Facility ID Number (12 digits) for the Initial Temporary Storage Facility used

Col 7. List the temporary storage facility handling codes

Col 8. List the European Waste Code Number(s)

Col 9. List the final TSDF disposal manifest (last five digits)

Col 10. List the BOSS Facility ID Number (12 digits) for the Final TSDF Disposal Facility

Col 11. List the quantity disposed

Col 12. List the final disposal handling codes

Col 13. Provide the date accepted at the Treatment Storage Disposal Facility (TSDF)(mm/dd/yyy)

DRMS FORM 1683e, JAN 00 (MH)