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ORDER FOR SU-31_IES OR SERVICES (Contractor must sum four copies of invoice.) oNenPPrCVeai87 I 1 of 2 Expires G0c 31, 1993 Public reporting burden forthis collection of infortretion is estimated to average 35 minutes perresponse, including thetime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,and completing and reviewing thecollection of info mation. Send comments regarding estimate orarry other aspect of this collection of information, including suggest ens for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for informati on Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-02;5), Washington, DC 20503. PLEASE DO NOT RETURN YOUR FORM TO EITHER OF THESE ADDRESSES. SEND YOUR COMPLETED FORM TO THE PROCUREMENT OFFICIAL IDENTIFIE EM 6. 1. CONTRACT/PURCH ORDER NO. 2. DELIVERY ORDER NO. 3. DATE OF ORDERREQUISITION/PURCH , REdWct V UtiolliTf (YYMMMDD) T SP4500-08-D-0019 1633 13 Oct 18 SEE SCHEDULE 6. ISSUED BY CODE SP4500 7. ADMINISTERED 6Y CODE DEF REUT & MKT SVC/DRMS 5. DELIVERY FOB FEDERAL CENTER 74 N WASHINGTON AVE 0 DEST BATTLE CREEK MI 49017-3092 [3 OTHER (See Schedule if other) 9. CONTRACTOR CODE 1 NFA4 FACILITY CODE 10. DELIVER TO FOB POINT BY (Date) 11. MARK IF BUSINESS IS CLEAN HARBORS ENV SVCS INC MUMMDO' 13 Nov 04 1501 WASHINGTON STREET ❑SMALL 12. DISCOUNT TERMS BRAINTREE, MA 02185-9048 ❑ SMALL DISADVENT MAIL INVOICES TO ❑ WOMEN -OWNED SEE BLOCK 15 14 SHIP TO CODE 15. PAYMENT WILL BE MADE BY CODE H001 31 MARK ALL SP4500-08-D-00191633 DEFENSE FINANCE & ACCOUNTING PACKAGESAND ATTN DFAS-COITLCO PAPERS WITH SEE SCHEDULE P.O. BOX 369016 CONTRACTOROFUER rn I1MR11S OH 4B93F_gp ,R NUNBER 16.X This delivery order is issued on another Government aaencv or in accordance with and subiect to terms and conditions of above numbered contract. TYPE DELIVER Reference your furnish the followinc on terms soecified herein i OF PURCHASE ACCEPTANCE. THE CONTRACTOR HEREBYACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY ORDER PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMSAND CONDITIONS SET FORTH, AND AGREES TO PERFORM NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED (YYMMOD) ❑ If this box is marked, supplier must sign Acceptance and return the following number of conies 17. ACCOUNTING AND APPROPRIATION DATE/LOCAL USE 18. 19. 20. QUANTITY 21. 22. 23. ITEM NO. SCHEDULE OF SUPPLIES/SERVICE ORDERED/ UNIT UNIT PRICE AMOUNT ACCEPTED' DOCUMENT NOUN DTID AC 0001 3290FCRO SB320032750001 32,000 P 0.27 8,640.00 9106RR 9140, SB3200-S11-087, ASD 2013-10-02, UN1993 WASTE FLAMMABLE LIQUID,NOS (GASO LINE), 3 PGI, 1 X 12,000 l GALLON CAP. WITH APPROX 400GALLONS REMAINING IN TANK #156 (GASOLINE), LOCATED AT SHARPE DEPOT I BYFIRE DEPARTMENT, D001, D018, CA214, CA8210020832, • Ifquantity a=epted by the Government is same as 24. UNITED STATES O F AMERICA 25. TOTAL 11,575.00 29 quantity ordered, indicate by lfdfferent, erreractual quantity accepted below quantity ordered andenchcle. BY. CONTRACTING/ORDERING OFFICER DIFFERENCE 26. QUANTITY IN COLUMN 20 HAS BEEN 27. SHIP NO 28. D.O. VOUCHER NO. 30. INSPECTED .RECEIVED ACCEPTED, AND CONFORMS TO THE INITIALS CONTRACT EXCEPT AS NOTED ❑ PARTIAL 32. PAID 6Y 33. AMOUNT VERIFIED CORRECT FOR ❑ FINAL 31. PAYMENT ❑ COMPLETE DATE SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 34. CHECK NUMBER 36. 1 certify this account is correct and properfor Dayment. 0 PARTIAL 35. BILL OF !AGING N0. ❑ FINAL DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER 37. RECEIVED AT 38. RECEIVED BY(Print) 39. DATE RECEIVED 40. TOTAL CONTAINERS 41. SIR ACCOUNT NUMBER 42. SIR VOUCHER N0. 1 (YYMMMa01 DD FORM 1155, APR 93 (EF) PREVIOUS EDITION MAY BE USED.