HomeMy WebLinkAbout326857 06/29/18 �/ �� CITY OF CARMEL, INDIANA VENDOR: 372441
iI ONE CIVIC SQUARE US ECOLOGY LIVONIA, INC. CHECK AMOUNT: $*****8,391.55*
��; CARMEL, INDIANA 46032 PO BOX 936227 CHECK NUMBER: 326857
'''�:an�. ATLANTA GA 31193-6227 CHECK DATE: 06/29/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 419431 8,391.55 OTHER EXPENSES
VOUCHER NO. 181905 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995)
ALLOWED 20
Vendor # 372441 IN SUM of$ ACCOUNTS PAYABLE VOUCHER
US ECOLOGY LIVONIA INC CITY OF CARMEL
1.7 wn 1396 L rISr .,,,,,;,.., rY An invoice or bill to be properly itemized must show: kind of service,where performed,
r 1VONIA, 4 48 _ _ dates service rendered, by whom, rates per day, number of hours, rate per hour,
Gk 73— -7 numbers of units, price per unit,etc.
Payee
$8,391.55 372441 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR US ECOLOGY LIVONIA INC Terms
Carmel Water Utility 17440 COLLEGE PARKWAY Due Date
BOARD MEMBERS
I hereby certify that that attached invoice(s), LIVONIA, MI 48152
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
419431 01-6360-04 $8,391.55 and received except 6/20/2018 419431 $8,391.55
1 hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited
same in accordance with IC 5-11-10-1.6
Cost distribution ledger classification if claim paid motor vehicle highway fund. , 20_
Clerk-Treasurer
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INVOICE
CARMEL WATER UTILITIES Invoice:419431
3450 W.131ST P.O.#:KRO51518 Invoice Date:6/13/2018
CARMEL,IN 46074-8267 Customer ID:600180
ATTENTION:Accounts Payable
AX Customer ID: CO26635
.. .E �nYOlCe.SultllllclMCI
Work Order Charges $7,716.55
Energy, Insurance and Recovery Fee $675.00
Please Pay By 07/28/2018: $8,391.55
Invoke Def<at
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Work Order:22709900 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(1777 EQIS Indianapolis Transfer and Processing
Transportation of waste to US Ecology Detroit South
Manifest#010313567JJK
Reference ID Qty. Unit Price Ext.Price
14-06 22709900-1-1 Manifest:010313567JJK-1 P.O.#:KRO51518
5/31/2018 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Hydrofluorosilicic Acid 5.00 T275 $1,350.00 $6,750.00
Disposal:EQDET/E187070DET Man/BOL:010313567JJK
-----.._._..._............_.._.—.....................-----..__........................................—_.._................._..._........-----------............................._..._---.................................._---......_...._..............._..._
14-06 22709900-2-1 P.O.#:KRO51518
5/31/2018 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
STOP FEE 1.00 EACH $350.00 $350.00
..._......_..---.._ _....---....._........-----........................_....--..---...._._............................._-----....................--------..__......._..........................__.._._.._.—_._...................._.._....--- _...._..._.......-----.—._.........._._._.._.._
14-06 22709900-3-1 P.O.#:KRO51518
5/31/2018 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Transfer to Detroit through Indy 10 day facility 5.00 T275 $110.00 $550.00
14-06 22709900-4-1 P.O.#:KRO51518
5/31/2018 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
State of MI Hazardous Surcharge 5.00 EACH $11.00 $55.00
14-06 22709900-5-1 — P.O.#: KRO51518 _ — _
5/31/2018 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Wayne Disposal Host Fee 5.00 EACH $2.31 $11.55
_......---..._.................---------.........................--—..-_......................................------........................-._._................_....-----.._._........._.- ---.-----
Subtotal: $7,716.55
Payable to US Ecology [vonla, Inc
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A#lama,GA 31193 6227 Please PayInU S Funds Only By 7/28/2018
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US Ecology Livonia,Inc. is a separately incorporated entity that provides administrative services to the US Ecology,
Inc.affiliated group of companies. This invoice was prepared by US Ecology Livonia,Inc.on behalf of the following
US Ecology affillate(s): EQ Industrial Services, Inc.
Customer Service: 1-800-592-5489 www.usecology.com
600180 (1362791 r1)
Page 1 of 2
usecology
INVOICE
CARMEL WATER UTILITIES Invoice:419431
Customer Service: 1-800-592-5489 www.usecology.com
600180 (1362791r1)
Page 2 of 2
Invoice: 419431 Workorder 14-06 22709900 Manifest MANIFEST#2
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4915 E 106TH ST
1NDIMUPOLIS,IN 46290
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Page 1 of 2 10972448
Invoice: 419431 Workorder 14-06 22709900 Workorder document WORKORDER DOCUME
Trip ID:59213 Stop;1
ub a co Io g\/ Work Order:22709900
C �I Reference Code:
Emergency Project:
P
EQIS Indianapolis Transfer and Processing Response 0:(317)5714144 Arrival AX AA P Time:
2650 N.Shadeland Avenue Phone:1-800-592-5489
Indianapolis,IN 46219 Fax:1-800.592-5329 Date'
Prepared By:Jessica Nails
BILLING INFORMATION GENERATOR INFORMATION
Name:CARMEL WATER UTILITIES Contact: Name:CARMEL WATER TREATMENT Contact:
Acct M'1100180-99 Title: EPA M INR000145524• (0,17716)- Title:
Phone:(317)733-2855 Phone: Phone:(317)5714144 Phone:( ) -
Addr.4915 E.106TH STREET Mobile:( ) - Addr:4915 E 106TH ST Mobile:
INDIANAPOLIS,IN 46280-3800 PO!Rel: INDIANAPOLIS,IN 46280
TSDF INFORMATION
TSDF: EQ DETROIT,INC. EPAM MID980991566
Addr. 1923 FREDERICK STREET Phone:(313 347-1300
DETROIT,MI 48211 Fax: (313)923-3375
Comments:
ao d is
Start Date and Time: End Date and Time: Total Hours:
Supplies QtvBi11 Unit QN Rea Description Supplies gq( ill ni Otv Ren Descriphon
Other 9htI@ n UnitQ
tvReaDescrlofio Other Qyt it N ON Rep Descrimion
Pickup Date Time Explanation
Arrive at Shipper:
Start Loading:
Finish Loading:
Leave Site:
SHIPMENT RECEIVED INAPPARENT GOOD ORDER(CONTENTS UNKNOWN) THIS IS TO CERTIFY THATTHE ABOVE NAMED MATERIALS ARE PROPERLY CLASSIFIED.DESCRIBED,
SUBJECT TO THE TERMSAND CONDITIONS OF THE UNIFORM STRAIGHT PACKAGED,MARKED AND LABELED AND ARE IN PROPER CONDITION FOR TRANSPORTATION ACCORDING TO
BILL OF LADING AND ANY GOVERNING CLASSFICATIONS AND TARIFFS THE APPLICABLE REGULATIONS OF THE DEPARTMENT OF TRANSPORTATION.
LAWFULLY ON FILE ON THE DATE OF SHIPMENT
Driver Signature Date Customer Signature Date
Delivery Date Time Explanation
Arrive at TSDF:
Start Unloading:
Finish Unloading:
Leave Site:
Driver Signature Date Receiver Signature Date
US Ecology Authorized Representative Date Onsite Representative Date
Please comment on the job so we can continue to provide better service: Excellent 0 Satisfactory F] Poor
14-06-22709900
Page T of 1
Page 2 of 2 10972447
US ECOLOGY
Lancs Disposal Restriction & Certification Form
Gmea tor. CAPZM,ZVAZEa TREATMENT PLANT 1 U.S,EPA M Ne.: INRO00143324
4913 L+' 106YH ST. INDIANAPOLIS,IN'46260
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I hardy outify that aii infmmtion sub-aittrd ai this:yid all assomated d-,vumwt%is a nplety:and aco,?:-sate°to the bwA
of my kris ale.and inf ounati Lri.
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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039
UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Responsephone 4.Manifest Tracking Number
WASTE MANIFEST 474Se ,t1r pi 3 >e°^i .. f r r c, ' •-- c' "v 010313567
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5.Generator's Name and Mailing Address v;<<;; ?}; P,'t!?'l;i --�cam; P ,c�_,;E?, ;1 Gbperatoes Site Address(if different than mailing address)
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6.Transporter 1 Company Name U.S.EPA ID Number
7.Transporter 2 Company Name U.S.EPA ID Number
8.Designated Facility Name and Site Address EQ t-z-,ET R T� ING U.S.EPA ID Number
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Facility's Phone: )j' •?r�"-`x`3�FI
ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit
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15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged,
marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary
Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent.
I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We.
Generator's/Offeror's Pdntedrryped Name Signature Month Day Year
16.International Shipments
[=- ❑Import to U.S. ❑Export from U.S. '� Port of entry/exit:
z Transporter signature(for exports only): Date leaving U_.S.:
W 17.Transporter Acknowledgment of Receipt of Materials
12 Transporter.1 Printed/Typed Name Signature" , ' Month Day Year
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Transporter 2 Printed/Typed Name Signature Month Day Year
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18.Discrepancy
18a.Discrepancy Indication Space ❑ Quantity El Type El Residue El Partial Rejection 0 Full Rejection
Manifest Reference Number:
18b,Alternate Facility(or Generator) U.S.EPA ID Number
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19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
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20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY