Attachment_9_-_DLA_Qualified_Facility_List_Application.pdf

FIGURES 18

DLA Qualified Facility List Application

Official Facility Name: Enter Text Here Date: Click to Enter Date

Facility ID Number: Enter Text Here Facility Address: Enter Text Here

DLA Prime Contractor Name: Enter Text Here Contract # Enter Contract # Here

IMPORTANT – READ FIRST

This application is for entities seeking to be placed on the DLA Disposition Services Qualified Facilities List (QFL) and is designed to be completed and submitted electronically. Provide all applicable information and supporting documents with this completed application. Make proper selections for the subject facility. Only companies currently under contract or that are bidding on a solicitation with DLA Disposition Services may request consideration for placement on the QFL. Approval will not be granted until all required documentation and regulatory compliance status have been received and verified. Some requested information is applicable only to facilities in the USA. Please refer to Page 4 of this application for detailed instructions.

Section One – Permitted Treatment and Process Descriptions Process Descriptions Performed

On-site Process Descriptions Performed

On-site Process Descriptions Performed

On-site Physical/Mechanical Chemical Thermal

Subtitle C Landfill ☐ Solidification ☐ Incineration ☐ Subtitle D Landfill ☐ Stabilization ☐ Waste Fuels Kiln ☐ Lab Packing ☐ Paint Recycling/Re-use ☐ Solvent Recovery ☐ Battery Demanufacturing ☐ Neutralization ☐ Thermal Desorption ☐ Electronics Demanufacturing ☐ Solvent Recovery/Reactivation ☐ Smelting ☐ Storage ☐ Chemical Deactivation ☐ Waste to Energy ☐ Bulking/Consolidation ☐ Carbon Adsorption ☐ Retort ☐ Gas Recovery ☐ Chemical Precipitation (WWT) ☐ Other Phase Separation/Filtration ☐ Macro Encapsulation ☐ Click here to enter text. ☐ Deep Well Injection ☐ Micro Encapsulation ☐ Click here to enter text. ☐ Fuels Blending ☐ Chemical Transformation ☐ Click here to enter text. ☐ Shredding/Separation ☐ Dechloriination ☐ Click here to enter text. ☐

SP4530-15-R-0002

HW Philippines

ATTCHMENT 9

CONTENTS 19

Section Two - Management Methods and CLIN Treatment/Disposal Codes Management Method Codes and Applicable Process Descriptions Waste CLIN Treatment/Disposal Codes

Click here to enter codes. Click here to enter codes.

Section Three – Regulatory and Financial Assurance

Requirement Submitted Applicant Comments DLA Use Only

Verification Comments

1. According to the U.S. EPA Civil Enforcement Response Policy, have any RCRA Class One or Two Significant Noncompliance (SNC) violations been issued to the facility?

If yes, provide documentation. (US Facilities Only)

Click to Select Enter Text Here

☐ Click here to enter text.

2. Any administrative or judicial consent orders, corrective actions, or supplemental environmental projects in the last 3 years? If yes, provide documentation.

Click to Select Enter Text Here ☐ Click here to enter text.

3. In the last 12 months has your facility caused a government generator to have to file a manifest exception report in accordance with 40 CFR 262.42(a)(2), or a state equivalent? (US Facilities Only)

Click to Select Enter Text Here ☐ Click here to enter text.

4. Facility closure amount and mechanism (bond, trust, letter of credit). Provide copy of actual document.

Click to Select Enter Text Here ☐ Click here to enter text.

5. Current certificates of accord showing pollution liability and other insurance coverage.

Click to Select Enter Text Here ☐ Click here to enter text.

6. Facility permit(s) cover page(s) recording expiration date.

Click to Select Enter Text Here ☐ Click here to enter text.

7. Have any delays in returning signed manifests to the generator triggered exception reporting in the last year?

(US Facilities Only)

Click to Select Enter Text Here ☐ Click here to enter text.

CONTENTS 20

Section Three – Regulatory and Financial Assurance

Requirement Submitted Applicant Comments DLA Use Only

Verification Comments

8. Latest third party compliance inspection/report (Fed, State, Local, DLA) and documentation of corrective actions, no older than 18 months.

Click to Select Enter Text Here ☐ Click here to enter text.

9. Current facility environmental POC with phone number and e-mail address

Click to Select Enter Text Here ☐ Click here to enter text.

10. Current environmental regulatory agency POC with phone number and email address.

Click to Select Enter Text Here ☐ Click here to enter text.

Name of Person Completing Application: Phone:

Section 4 - Quality Assurance Verification. For DLA Use Only – APPLICANT DO NOT COMPLETE:

For CONUS facilities only. ECHO report reviewed?

Choose an item. Verifier Comments

History of significant non-compliance?

Choose an item. Click here to enter text.

Significant non-compliance corrective action schedule in place with regulatory agency?

Choose an item.

Repeated significant non-compliance issues?

Choose an item.

Applicable H039 treatment processes identified and placed in file?

Choose an item.

All documents in above application entered into TSDF paper file?

Choose an item.

CONTENTS 21

DSS table developed with approved waste codes and management method codes?

Choose an item.

QFL Database file developed? Choose an item.

All conversations/communications with regulators sufficiently documented in file?

Choose an item.

DLA Disposition Services employee conducting review and verifying all actions have been completed IAW Section 8 of DRMS-I 4160.14.

DLA Verifier Typed Name: Enter Name Signature: Date: Enter Date

CONTENTS 22

Applicant Instructions:

Official Facility Name Provide name of facility as it is assigned on any regulatory permits. Designate if using a dba.

Facility I.D. Number This number can be an assigned EPA I.D. number if the facility is in the USA or dummy number assigned by DLA personnel for facilities outside the United States.

DLA Prime Contractor Name Provide name of current DLA prime contractor.

Contract Number Provide DLA Contract number that is awarded to the prime contractor.

Section One – Permitted Treatment and Process Description(s)

Check all processes that are used to treat, store, recycle or dispose of material regardless if permits are required to be in place.

Section Two – Management Method Codes and Waste CLIN Treatment/Disposal Codes

For facilities regulated under United States laws, provide all management method codes or permitted waste codes used to treat, store, recover, or dispose of waste that correspond to the treatment processes designated in Section One. Management method codes can be found on the EPA web site in the Hazardous Waste Report Instructions and Forms booklet for the most current year:

http://www.epa.gov/epawaste/inforesources/data/biennialreport/index.htm. Waste CLIN treatment and disposal codes can be found in the applicable DLA Disposition Services Contract.

Section Three – Regulatory and Financial Assurance

Application Submitter

Many of the requirements in this section are designed for facilities located in the USA. If the facility is located outside the USA and the regulatory system does not support the requirement, please indicate so in the comments box. Do not leave a requirement unanswered and always provide the supporting documentation where requested. Not providing requested information and supporting documentation will only slow down the review process.

Print name and phone number of facility representative completing the application. Application will not be accepted without this information.

Section 4 – Quality Assurance Verification

Applicants should not complete Section 4. This section is for DLA use only.

http://www.epa.gov/epawaste/inforesources/data/biennialreport/index.htm