HomeMy WebLinkAbout330824 10/09/18 VOUCHER NO. 182888 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 n CITY OF CARMEL
tX An invoice or bill to be properly itemized must show: kind of service,where performed,
LIVONIA, MI 48152 �T�-�9" dates service rendered, by whom, rates per day, number of hours, rate per hour,
numbers of units, price per unit,etc.
Payee
$3,576.62 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
PO# ACCT# or bill(s)is(are)true and correct and that
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
442115 01-6360-04 $3,576.62 and received except 9/26/2018 442115
$3,576.62
I 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
Vsecoow
INVOICE
CARMEL WATER UTILITIES Invoice:442115
3450 W.131ST P.O.#:JF08142018 Invoice Date:9/21/2018
CARMEL,IN 46074-8267 Customer ID:600180
ATTENTION:Accounts Payable
AX Customer ID: CO26635
E
9,hAt,
tiF.a. Invoice: ummary y
Work Order Charges $3,576.62
Please Pay By 11/05/2018: $3,576.62
y InvoiceDeta�f
Work Order.23048200 Generator INR000145524 CARMEL WATER TREATMENT PLANT 1(1777 EQIS Indianapolis Transfer and Processing
waste,transportation,and disposal
refer to manifest 0207988 and 018354519JJK
contact:Jaimie Foreman 317-571-4144 jforeman@carmel.in.gov
BS05182018
Reference ID Qty. Unit Price Ext Price
14-06 23048200-1-1 P.O.#:JF08142018
8/30/2018 Generator:INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
_ e_Manifest Submission Fee,Data+Image Upload _ 1.00 EACH $10.00 $10.00
14-06 23048200-2-1 yROX:JF08142018
8/30/2018 Generator.INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Disposal-275 Gallon Totes of Hydrofluorosilicic Acid 2.00 EACH $1,350.00 $2,700.00
14-06 23048200-3-1 P.O. .JF08142018
8/30/2018 Generator.INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Transportation-Stop Fee 1.00 EACH $350.00 $350.00
14-06 23048200-4-1 P.O. .JF08142018
8/30/2018 Generator.INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Trans Ship to Detroit(275 Gallon Tote) 2.00 EACH $110.00 $220.00
14-06 23048200-5-1 ROA:JF08142018
8/30/2018 Generator.INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Labpack mm _ 1.00 EACH $270.00 $270.00
14-06 23048200-6-1 _ P.O.#:JF08142018
8/30/2018 Generator.INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
State of Michigan Hazardous Surcharge-275 Gallon 2.00 EACH $11.00 $22.00
14-06 23048200-7-1 P.O.*'JF08142018
8/30/2018 Generator.INR000145524 CARMEL WATER TREATMENT PLANT 1(177716)
Wayne Disposal Host Fee-Tote 2.00 EACH $2.31 $4.62
Subtotal: $3,576.62
Customer Service: 1-800-592-5489 www.usecology.com
600180
(1386488x1)
Page 1 of 2
INVOICE
CARMEL WATER UTILITIES Invoice:442115
Payable to kUS Ecology L''ivonia Inc £ 4
. :.
s
w
PQ Box 936227 "
Invoice 442115
{ Atlanta GA 31193 6227 Please Pay in U S Funds Only By ` 11/5/2018 .E
c c�] p
! eY: �i3{��i,xu..•W.wo-..� ✓`
$3,5
Amou
... �... nt Du � 7
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 affiliate(s): EQ Industrial Services,Inc.
Customer Service: 1-800-592-5489 www.usecology.com
600180
(1388488x1)
Page 2 of 2
::US 1
Table of Contents
for Invoice 442115 Dated:912112018
CARMEL WATER UTILITIES
Document Page
Manifest MANIFEST#1 for Workorder 14-06 23048200 1
�Manlfest DO�G112�40425 CARM��DET MAN�PDF for Worl�orde�14`Q6 2304��20�
Customer Service:1-800-592-5489 www.usecology.com
600180
tc-1
Invoice: 442115 Workorder 14-06 23048200 Manifest MANIFEST#1
-5700V `
I
NON4JAZARDOUS I.Generator ID Number 2.Pepe 1 of a Epyryep4Y Besponseppry a 4.W124 Traeiary Number
WASTE MANIFEST INR 000145 524 1 1�s i 4 I T 144 02 7 9 8 8
5.Generld&z Name and MarkAddressPLOW
s Ste Addresg(b diRerent than ma�rg address)
4915 E 106THIT
INDIANAPOLIS.IN 46280
Generators Phone: (317)571-4144
6.Transporter 1 Company Name
EQ INDUSTRIAL SERVICES U.S.EPA ID Number
MIK 435 642 742
7.Transpemer 2 Company Name U.S.EPA ID Number
e.Desipwle0 FaUily Name and sae AWNS EQIS TRANSFER&PROCESSING U.S.EPA ID Number
2650 N.SHADELAND AVENUE INR 000125 641
INDIANAPOLIS,IN 46219
Faaa s Phme: (317)247-7160
9.WastS Shippirg Name and Desalptial 10.CenWnem 11.Total 12.Ilett
No. Typo omit, M Vol.
e ' Non4ieguhted Mattelial 001 TP 01042 -P
u
2.
a
4.
1.1 Specht Hardng InsMora and Adam=Wore m
1.G1500111PID i Rtn;e WitsuRwd"Hydlnlblorosrben;sold IT 1406.6131311
14.GENERATOR'SIDFFEROR'S CERYMTIDV I hereby dedare mat the contents of INS oonsipomerd are fury and acwratety descnbed oboes by the proper sh
mwrksd wd sa eb4lacarded.aW aro h al respells m propel caMlaar,Ior banepom aaordNg m ��= and retia>al Ong rte•erd are classified. ckaged,
.
G rat�YsfOfte a*,Prin yped Name S" Montn Year
M 08 0 18
Imemat oral Sleprnenls
11uq.41oU.S. ❑FWnfmm .. Pod ofm4lesib
Tramaef Siamave(ror Dale le U.S.:
s 16.Trdsssportar Ad Mwiedp n d of Receipt of Malafats
ITraULo ter 1 P ed? Name .001
p J Moth Year
OL r 08 01-18
` Transpoder2 PrWofTyped Name
Month C By Year
17.Dwmpatq
17a Drserepanry Indiratbn Space
❑a°mm1 ❑Type ElResidue IDPadiel Re(eclion ❑Fu9 election
hlaniiest Reference Number.
uT 17b.Altemate Fa64(a Generaioq U.S.EPA ID Number
CJiar Fad q+s Phone:
s7c.SWQluraofAkemateFadify(or Generamr) Month I I my Year
Ln
H141
1&DesVWod FaaRy Omw a Operator.Cwtftuon oi receipt of materials covered by me manifest escapt as rated in Item 17a
Pdmad?yped Name agro" MoTth---V y Year
189 BLC06 10499(Rev.9109) DESIGNATED FACILITY TO OEA ERATOR
Page 1 of 2 11240426
018364519JJK
Please print or type.(Form designed for use on elite(12-pitch)typevrriter.
UNIFORM HAZARDOUS 1.Generator ID Number Form Approved.OMB No.2050.0039
2,Page 1 of 3.E nse Phare (fest racYing Num r
WASTE MANIFEST INR 000 145 524 1 -41+4 p g r JJK
5 Generator's Name and Malting Address E P aratO Site Address IR different than mailing address)
4915E 106TH ST
INDIANAPOLIS, IN 46280
Generatar's Phone: (3171571 144
6.Transporter 1 mpany Name
EG INDUSTRIAL SERVICES U.S.EPA Number
7.Transporter 2 Company Name MIK 435 642 742
U.S.EPAID Number
8.Des gnaled FaaTity Name and Site Address
EQ DETROIT,INC. U.S.EPAID Number
1923 FREDERICK STREET MID 9$0 991 566
DETROIT, AAI 48211
Facility's Phone: 13)347-LMO
9a. 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number. 10.Con are HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codas
No. Type Quantity WWII.
X 1" UN 1778,Waste.Hydrafterosiliac acid,8,PGII,FRG#154 001 TP 01918 P
W
W 2.
C7
3.
4.
14.Special Handkng instructions and Add taanformation
I E1fl7070DET r H7do3fluam,INeIC/kcid(T.14.0B 81373 1)
I5. GENERATOWS10FRROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are Wy and acrauately described above by the proper shipping name.and are dassified packaged
marked and labeledlplacaided.and areina0 respects m proper Condition for transport according I applicable irgemational and national govemmengt regulations.R e rtahi
Exporter,I Corti*that the Contents of this consignment conform to the terms of the attached EPAAcknoMedgment of CoMAL pment anti I am the Pdmary
I caro*that the waste mmrmizatan statement identified on 40 CFR 282.27(a)(if I am a targe quantity tor)of(b)(d I am a small quantity generator)is hue.
neratoeslCterofs Prate Name Signal e
Month Day Year
Yy nn
F 1 .rntemation hipments 08 30 18
❑Import to U.S. ❑Export he Port of entry/exit:
= Transporter signature(far exports onry):
Date leaving U.S.:
K 17.Transporli rAdmowledgment of gexiptof Matedais
nansponer 1 nnied *ped Name
t� 3 nature,,< Month Day Year
a Transporter 2 PrintsdIT Name0$ 30 1$
H aNto Month Day Year
18.Discrepancy
18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue
❑Partial Rejection ❑Full Rejection
lab.Alternate Facility Io Generator) Manifest Reierenoe Number
U.S,EPA 10 Number
2 FacilitoPhone•
0 loc.Signature ofAftemate Facibry(or Generator)
i
Month Day Year
19 Hazardous Waste Report Management Method Codes(is.,codes for hazardous waste treatment disposal.and retyrLng systems)
1
o H110 2 3 4.
20.DesignzW FacMty Ownar or Operator Certification of receipt of hazardous matedala covered by the manifest except a%ncMd in Rem 18a
Pwh6Kd1/7Tvw Narq S gnatu
Month yr
EPA Form 870M2(Riev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTIN TATE(IF REQUIRED)
Page 2 of 2
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 Response Phone 4.Manifest Tracking Number f .7
b f "f 3�t-1 1 (� cy k L
WASTE MANIFEST 4 I i�uI ,➢,i:'k b I '�1 ( � tt t`?JJ K
,I: ,tla°11 ;rr+aPr; \1�: " <<,i'3a..$412 eJ
5.Generators Name.nhd Mailing Address rti, V1,1Wtz L VVII.1 :� L S ki F 1,41"Z11.i t'IGeherators Site Address(if different than mailing address)
49
r,.r , 5�1 I A �..t.
Generator's Phone: 'A" � _
`""
6.Transporter 1 (yCompany Name U.S.EPAID Number
rEQ x+'46-1-3i fc0 gIY3.;�` L I"$'c L`Jk.. 435 'i,+t`p 742
7.Transporter 2 Company Name U.S:EPA ID Number
8.Designated Facility Name and Site Address. EQ I)ETRUT, i<- U.S.EPA ID Number
'1923'y7^g"�gi E.y,,a*t~'PRIl�C�E' 9L..'4'YY'xlT, `L 1'?f6T r.a !1'430
rk,,;�`^'�'Lir.d 4 s 1Y�d'•: /ti:dH'.`d Y o
p
Facility's Phone: .-)' �
9a'._ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes
HM and Packing Group(if any)) No. Type Quantity Wt./Vol.
O
Z 2.
w
c�
3.
4.
14.Special:C_trit1:±-Handling.lr�structions and Additional Information
.
15. GENERATOR'SIOFFEROR'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 true.
GQr erator's/Offerors Pnntedfr ed Name Signa re Month Day Year
C* e
16.International Shipments - ❑Export from U.S) Port of en /exit:
F— Import to U.S. ptry -
z Transporter signature(for exports only): Date leaving U.S.:
LU 17.Transporter Acknowledgment of Receipt of Materials
F Trens oder 1 Printedfr ed NameSi nature r f..' Month Da Year
O
QTransporter 2 Printedfryped Name r ,Signature Month Day Year
F
18.Discrepancy
18a.Discrepancy Indication Space ❑ Quantity - ❑Type
❑Residue El Partial Rejection El Full Rejection
Manifest Reference Number:
18b.Alternate Facility(or Generator) U.S.EPA ID Number
..r
U
LL Facility's Phorie:
L—
18c.Signature of Alternate Facility(or Generator) Month Day Year
Zfete :
N19.Hazardous Waste Report Management Method odes i.e.,c es for hazardous waste I; ystems) .
1. 'AS 4:
Pped
nated Facility Owner or Operator:Cedifica n of receipt of hazardous materi c reb th ani e e noted in Item 1 a
Name U s e.• Month Day Year
EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY
X13 '
NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number
WASTE MANIFEST (a1!) 5 7 11.-4)
5.Generator's Name and Mailing Address C*AR#Wc1 Wf r + TREATUENT f.3LGe6eralo'rs Site"Addresss'(if different than mailing address)
" 8T
INIDIANAPOLI�-3, IN 46280
Generator's Phone: 'U-J-d i-14
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 p y^, f•, — 1 fS ,•.G ,p ;!3 �. U.S.EPA ID Number
'%Jn S'g�:..i�t...,�5::.:.7gT���4�t:,5 g ,�• g
Facili 's Phone: €1,i € _'`� 1-7 16 0
9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit
No. Type Quantity Wt.Nol.
O I✓'104-2 P
Q
rr
w
z
w 2.
3.
4.
13.Special Handling Instructions and Additional Information
'f. '��F'�:I`:i i��s'S;_S �c'S,es*3'y :?1<i>Fi°.a;:tti:..%3��'lyr�St'r_.�•s•:•ii 1+:P� ',a;P: ;T'
14.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 appliGake international and national governmental regulations.
Gneratoris/Offeror's Print yped Name Signafu, Month Day Year
YwC
to
International Shipments
L1 Import to U.S. ❑Export tram U.S. Port of entry/exit:
Transporter Signature for exports only): Date leaving U.S.:
cc w
16.Transporter Acknowledgment of Receipt of Materials
Transporter 1 Printedfryped Name Signature ;�' !' e'J` Month Day Year
CL _ t` �' � 4i• f-r 'a t ? �'� ��. %y .f:- Y,7 i ./ J lP$3 ..rki' $t�
-
z Transporter 2 Printed/ryped Name Signature Month Day Year
r/
17.Discrepancy
17a.Discrepancy Indication Space El Quantity Type Quantity yp El Residue El Partial Rejection ❑Full Rejection
Manifest Reference Number:
F 17b.Alternate Facility(or Generator) U.S.EPA ID Number
J
U
ua. Facility's Phone:
w 17c.Signature of Alternate Facility(or Generator) Month Day Year
z
0
rn
Lu
v
18.Designated Facility Owner or Operator:Certification'of receipt of materials covered by the manifest except as noted in Item 17a
Printedfryped Name Signature Month Day Year
169-BLC-0 6 10498(Rev.9/09) �f GENERATOR'S/SHIPPER'S INITIAL COPY
s
US ECOLOGY
Land disposal. estric-don & Certification ri orm
CC*e7gwatCoL' ,..".1 i��' S:L'4��:�:CFi 'i`F;?. ]T,. TT P,.,1 d'I 1 �t.S.I;T'11 ► �la�.: Zi3£ti? �i�: �
4, 915 R 106TH 3'T, IKIDI Aitrr`ILIS,IN'46VW)
1.1anfl`ea.
liRltlfl4@fOC`i^]i�8!��"9E ,WEIR Aisl
3.ita :
1-01 Appm;vayl:.I
Waste CICKWr0y;
:rt3i13�:i$egtl9;'V: 1)M2 +.it_ 1iCSub C'3�ieggcvy
s:.emiflia tion; a,ED-'J+P.S'."1 '_E -RES�T���L�r��'a�)TFE.r�,.k L.C,6 _fir 9T.�'#ZJ? RD:
Tbio vmlemuv%be treated to the applicahle perfm mance Ga'i treatanent t,ndr.; d-;At futh in 40CFEZ Pwt 268
Sat,Idau {"�,e.� uk, ,l-t�p Zk. Cs crRCTt :iersScasCfi1�cl prjc lalil.3.clig, wl.
T h' eb'i than ali!Lzfcmnat-I'm q.tl:Aratted cxz this and all amwcidol dnmpnrrt%is cxxup[,ple at-d accurateto the best
of 1Y1V firld inff"us-fla tjon.
Ge�ll�' Tt `.�_mfc SIgrtnt re `..L'{ '1��t �.: .0 i�, 1 i Title:
T'ute7
OWW201
Page 1 of 1