84  FORM FIN1510-01 For Accounts Payable Use Only Vendor Number 56576  GEORGIP  Rohficatal  CHECK REQUEST FORM  Copy  Uset this form to arrange for payment toi individuals or businesses when al Purchase Order or P-cardi is not required.  This form must! bes submitted in typed format only.  Vendor Information Date:  Vendor or Employee Name Miller Environmental Group  Department Name: Parks & recreation Ifp payment is to a Vendor, isal W-9 on file int the Purchasing Office? IFN No, a completed W-9 MUSTE be attached. Email Adrienne M. Brown in our Purchasing Division. adrennemibrowneroctdaecountygagow  Mailing Address PO Box 23481 New York NY: 10087 Email Address  EXPENSE/ACCOUNT DETAILS Date of Service or Invoice  Description (fori individuals, Services, Expense Reimbursements) Invoice:  General Ledger Account Fund Function Account Dept.  Amount $44,716.77  7/25/2024 100 6300 523200 61  Total Check Amount $44,716.77  DESCRIBE FULLY THE NATURE OF THE PAYMENT  bil5p Cleaniap  Dept. Designee see attached for signature Compliance Staff Date  Date  FINANCE APPROVAL Procurement Manager CHECK HANDLING INSTRUCTIONS  Date Date  ########  .Mail envelope).  6.PickUp-Approval by Chief Financial Officer 7.Sendi Inter- Department Mail  (Enclose attachments ifrequired inl letters size Available ati the Finance Office Front Desk after Will bep placed in mailbox after 2:00 p.m every Friday  2:00 pm every Friday  Please send this form with attachments to the Department of Finance. Each check request received Monday-Friday will  processed the following Friday.  M2    505-4430- 521300 -44  Invoice  Payment Instructions: All payments must! bei in USD & Referencel Invoice # NEW Remit to Address: MILLERI EMIOMMENTALGROUPINC P.O. Box 23481 New York, NY 10087  ht  4 Kba-s  MILLER B'ENVIPONMENTAL GROUPNC  OPP k RT au Job Site: $ Vibert o Johnny) bT Rockdale Co Fire Rescue 3530 E. Hightower Trail Conyers GA 30012 United! States  Bill to: Johnny, Vibert Rockdale County, 1496 Rockbridge. Road Northwest Conyers GA30012 United States    Services provided by: MEG Atlanta Operations Center. Questions please call us 770-888-1698.  Invoice #: PO#: Job:  10097137 GA23240161  Date: Terms: Due Date:  7/25/2024 COD 7/25/2024  Service Date Description  Quantity Units 1 Hour 7 Hour 7 Hour 7 Hour 7 Hour 7 Hour 7 Hour  Rate $338.00 $294.00 $180.00 $180.00 $180.00 $74.00 $70.00 32% $39.00 $139.00  Amount $338.00 $2,058.00 $1,260,00 $1,260.00 $1,260.00 $6,176.00 $518.00 $490.00 $1,008.00 $322.56 $156.00 $139.00 $295.00 $672,00 $693.00 $632.00 $651.75 $520.00 $536.25 $520.00 $536.25 Page1of4  06/09/2024- Emergency Response to Clean Up  Oil Release Project Manager (DT) Supervisor (DT) Haz Mat7 Technician (DT) Haz Mat Technician (DT) Haz Mat Technician (DT) Subtotal- Labor Response Truck 20 Box" Truck Subtotal- Equipment Fuel Surcharge Level D- Protective Clothing OilA Absorbent Pads (100ct) Subtotal- Materials 06/10/2024- Continue to Cleanup Oil Release Supervisor (ST) Supervisor (OT) Licensed CDL Class AD Driver (ST) Licensed CDL Class AD Driver (OT) Haz Mat Technician (ST) Haz Mat Techniclan (OT) Hazi Mat" Technician (ST) Haz Mat Technician (OT)  6/9/2024 6/9/2024 6/9/2024 6/9/2024 6/9/2024 6/9/2024 6/9/2024 6/9/2024 6/9/2024 6/9/2024  4 Day 1 Bale/100  6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 253-5902.  8 Hour 5.5 Hour 8 Hour 5.5 Hour 8 Hour 5.5 Hour 8 Hour 5.5 Hour  $84.00 $126.00 $79.00 $118.50 $65.00 $97.50 $65.00 $97.50  Past due invoices may! bes subject to 18% per annum interest charge. A 3%p processing fee wil applyt to any credit card payments. Effective January 1, 2024, the Risk, Security, and Compliance (RSC) feey willo change to1796. Questions? Contact AR@milerenv.com or phone (877)    Invoice  Payment Instructions All payments must! bei in USD &I Reference: Invoice#" NEW Remit to Address: MILLERI ENVPOMMENIALGROUFNG P.O. Box: 23481 New York, NY 10087  MILLER ENVIRONMENTAL GROUPINC Rate $65.00 $97.50 $81.00 $63.00 $65.00 32% $38.00 $306.00 $227.00  Service Date Description 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024 6/10/2024  Quantity Units 8 Hour 5.5 Hour 13.5 Hour 13.5 Hour 13.5 Hour  Amount $520.00 $536.25 $5,817.50 $1,093.50 $850.50 $877.50 $2,821.50 $902.88 $152.00 $612.00 $1,816.00 $2,580.00 $672.00 $252.00 $632.00 $237.00 $520.00 $195.00 $520.00 $195.00 $520.00 $195.00 $3,938.00 $810.00 $630.00 $600.00 $2,040.00 $652.80 $190.00 $612.00 $1,135.00 $100.00 Page 2of4  Haz! Mat Technician (ST) Haz Mat Technician (OT) Subtotal- - Labor Vacuum Truck 101 Wheel 3200 Gallon 20' Box" Truck Rack" Truck/Flatbed/4X4 Truck Subtotal Equipment Fuel Surcharge Level D- Protective Clothing Chest Waders with Suspenders 8" Dia. Absorbent Boom Subtotal- Materials 06/11/2024-C Continue to Cleanup Oil Release Supervisor (ST) Supervisor (OT) Licensed CDL Class AI Driver (ST) Licensed CDL Class AD Driver (OT) Haz Mat Technician (ST) Haz Mati Technician (OT) Haz! Mat Technician (ST) Haz Mat Technician (OT) Haz Mat" Technician (ST) Haz Mat Technician (OT) Subtotal- Labor Vacuum Truck 10 Wheel 3200 Gallon 20' Box Truck Rack TruckFatbed/AXATluck Subtotal- Equipment Fuel Surcharge Levell D- Protective Clothing Chest Waders with Suspenders 8" Dia. Absorbent Boom Misc- -Kayak  4 Day 2 Pair 8 Bafe/4  6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/202.4 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 6/11/2024 253-5902.  8 Hour 2 Hour 8 Hour 2 Hour 8 Hour 2 Hour 8 Hour 2 Hour 8 Hour 2 Hour 10 Hour 10 Hour 10 Hour  $84.00 $126.00 $79.00 $118.50 $65.00 $97.50 $65.00 $97.50 $65.00 $97.50 $81.00 $63.00 $60.00 32% $38.00 $306.00 $227.00 $50.00  5 Day 2 Pair 5 Bale/4 2 Each  Past due invoices may bes subject to1 18% per annum interest charge.A 3% processing: feev will apply to any credit card payments. Effective January1, 2024, the Risk, Security, and Compliance (RSC)f fee will change to17%. Questions? Contact/ AR@milerenv.com or phone (877)    Invoice  Payment Instructions, All payments must bei in. USD&R Referencel Invoice# NEW! Remit to Address: MILLER ENVIRONMENTAL GROUPI INC P.O. Box: 23481 New' York, NY1 10087  MILLER ENVIRONMENTAL GROUPNC Rate  Service Date Description  Quantity Units  Amount $2,037.00  Subtotal-N Materials Disposal tol PCW Supervisor (ST) Supervisor (OT) Licensed CDL Class Al Driver (ST) Licensed CDL Class Al Driver (ST) Licensed CDL Class Al Driver (OT) Haz Mat Technician (ST) Haz Mat Technician (OT) Haz Mat Technician (ST) Hazi Mat Technician (OT) Subtotal- Labor Vacuum Truck 10 Wheel 3200 Gallon Vacuum Truck 10 Wheel 3200 Gallon 20' Box" Truck a-TncPabeda4Tuc Subtotal- Equipment Fuel Surcharge Level D- Protective Clothing 8" Dia. Absorbent Boom Misc- - Kayak Subtotal- Materials Disposal PCW 06/14/2024- Driver to take PCW to Shamrock for Disposal. Licensed CDL Class AI Driver (ST) Subtotal Labor Vacuum Truck 10 Wheel 3200 Gallon Subtotal- Equipment Fuels Surcharge Level D- Protective Clothing Subtotal Materials  06/12/2024- Continued: to Cleanup Oil Release &  6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/12/2024 6/14/2024 6/14/2024 6/14/2024 6/14/2024  1.5 Hour 6 Hour 2 Hour 1.5 Hour 6 Hour 1.5 Hour 6 Hour 1.5 Hour 6 Hour 7.5 Hour 2 Hour 7.5 Hour 7.5 Hour  $84.00 $126.00 $79.00 $79.00 $118.50 $65.00 $97.50 $65,00 $97.50 $81.00 $81.00 $63.00 $60,00 32% $38.00 $227.00 $50.00 $0.30 $79.00 $81.00 32% $38.00  $126.00 $756.00 $158.00 $118.50 $711.00 $97.50 $585.00 $97.50 $585.00 $3,234.50 $607.50 $162.00 $472.50 $450.00 $1,692.00 $541.44 $190.00 $1,135.00 $100.00 $1,425.00 $690.00 $197.50 $197.50 $202.50 $202.50 $64.80 $38.00 $38.00 Page 3of4  5 Day 5 Bale/4 2 Each  2,300 Gallon 2.5 Hour 2.5 Hour  1 Day  Past duei invoices may bes subject to 18% per annum interest charge. A 3% processing: fee wifla applyt to any credit card payments. Effective January1 1, 2024, the Risk, Security, and Compliance (RSC) fee will change to1796. Questions? Contact AR@milerenv.com or phone (877)  253-5902.    Invoice  Payment Instructions All payments must! bei in USD &T Reference Invoice# NEW Remit to Address: MILLER ENVIRONMENTAL GROUPI INC P.O. Box 23481 New York, NY1 10087  MILLER ENVIRONMENTAL GROUPNC Rate $0.30 $65.00 $63.00 32% $38.00 $80.00 $38,219.46 Subtotal Tax (%) Total Amount Paid Credit Applied Amount Due  Service Date Description 6/14/2024 7/17/2024 7/17/2024 7/17/2024 7/17/2024 7/17/2024 7/17/2024  Quantity Units 3,000 Gallon 3 Hour 3 Hour  Amount $900.00 $195.00 $195.00 $189.00 $189.00 $60.48 $38.00 $38.00 $160.00 $6,497.31 $44,716.77 $0.00 $44,716.77 $0.00 $0.00 $44,716.77  Disposal -Oily Impacted Water 07/17/2024- Disposal of Oil Impacted Debris to Shamrock for Disposal. Hazi Mat Technician (ST) Subtotal Labor 20' Box" Truck Subtotal- Equipment Fuel Surcharge Level D - Protective Clothing Subtotal- Materials Disposal - Drums- -Solids Risk, Security & Compliance Fee  1 Day 2 Drum 0.17  Past due invoices may: bes subject to 18% per annumi interest charge.A A 3% processing feev will applyt to any credit card payments. Effective January1 1, 2024, the Risk, Security, and Compliance (RSC) feey will change to 17%, Questions? Contact AR@millerenv.com: or phone (877)  Page 4of4  253-5902.    Material Name: Non-RCRAI Impacted Absorbent Matenal Bolid  PorA Assistanced Contact Cuetomer Bervloe: 1-000-881-4008  SHAMROCK GNvtaon MENTA ORPODATION  AQUACLEAN NAMROGK COMPANY fforofice use)  ONEW PROFILE  DRECERT  Material Charadterization Profile Proflle No:  Section  Generator Name: Rockdale County Fire Department Generator! EPAID: Plckup Address: 3550EHightower Trall Email: Phone: Socton2 a Shamrock Richmond' VA No: Matarios pintyadireet) Section  Genoratar mormallon Conyers, GA. 30012  Billng Contact: Miller) Environmental Group Biling! Name: Mike Thomas Bling Address: 4625S Stonegate Industrial Blvd Billing Phone: 470-230-1050 Blling Fax:  Stone Mountain, GA, 30083  Technical Contact: ChlefM Marlan McDaniel /Depuly Chiefs Sharon' Webb Biling Email: mihoma@nlerenwcon  Fax:  Maillng Address: 14961 Rockbridge Rd. NW  Conyers, GA. 30012  Shamrock Fachiy (ssuer AADrOVAISE AGCIIDAICS Check afofonflale destinations teslediocmatuaton).  a Shamrock Corporate Park Drive Browns Summit, NC OShamrockiAqua Clean Environmental Lakeland, FL  BA Aqua-Terra Oxford, GA a FER Oklahoma Clty, OK  aThird Parly Site (Istl Fknown/designated), iles y rogulre addionala MtINsyeNes logumonlatla.  Material fson poi aohatotarislics  Name of Material: Non-RCRA Impacted Absorbent Material Solld Industilal Process Generating Materia!: Clean upi from spll Slte Activity Generating! Materlak NO.  Metal Finishing Waste? Yes Nolfys. Complole Molal Finlehing Chackist Frequency: E Once EDlly Monthly Yearty Does the fuel mixture oontain levels of hazardous constituonts above those found Int the source ofthef fuel? OYes @ No DINA  Shipping information:. Quanly 2 Units: Gallons CubicYards Tons Totes a Drums  Contalner Typeloltpping Frequercy: Bulk BC/Tote Drum Other Doest the frel, cootaln ethanol? Yes No ONA Estimaled Ethanol Conc:  I8 ther materlal offisnecfication or disoarded commercial producl? Yes B No Fyes,Ien SDS évitllable? ElYes No SDS attached.  ist ther material a fuel, fuel component orf fuel mixture? D Yes B No List fuel(s):.  Jai the materlal! Ignltable? 8) Yes No Is! the materlal corrosive? Yes No Is ther material reactive? yes No Ist ther materlal a hazardous waste as definad! InF RCRA (40CFR $261)? D Yes a No DExcludedExampt lfyes, list waste codes: Is! ther materialwastowater, sublect toac CWAC Gategarical Pretreatment Standard (40 CFR 5400-471)9 a NA Yes JNo List Are any biofoxic components pronenti int the materials such aa cyanlde. chlorine, elhylene alycol, eto.? DYes No Liat:, Aret there any known UV1 Transmittance issues witht the wastewater? NA Yes E No Provide UVT% Value:. Source of gala/nformation usedt to upport! Ws prefle fsheck al applicable): JA Anelytical Data a Generator Knowledge Technical Data  Composition (key compounds, soll, water, PPE, debris, etc.):  Used OI (40 CPR $279) &V WTE Management Parameters: ONA Osi,000ppm 042(BTUHO0OD) Os2% s4,000ppm 02-S(PTUOOOD) MNA >1000R Rebultable? 09-2TUROOD) Ash(%): OYes ONa 0>12(BTUAOOD) 91%  Motor Oll Absorbent Materlal  to, 5 % Halogens/TOX: BTU Value:  Sulfur:  Moisture: NA Viscosity (sus): NA TDS/Conductivly: TDS (rarge) ppni Conduotvily (rango): Ouhos/cm. D uelen Chlarklas. ppa. CYes EN No Conc Dioxins? Dyes No Radloactive? DYes No Conc: enm Pago 10f2 SECF Profie Revo 04/2023  to 96  a. SNA Flash Point: 0<130F 0140F a 140-200"F >200*F Cyanides: a None  <0.02p ppr 001 ppm ppm Desppm Sulfides:  059(BTUDOOD) GNA Viscosfty: TSS: O200ppn D1,000ppm 01,000101 10,000ppm ENA Agents?: OYes No Myes. Jst: ppm  leralerlald darivedf from! Horizonial Dieclionall Drating(HDD)?: ay Yos ONo  NA  Description: Color: Physical State @ 70°F: pH: (chocka althat apply) O Freel liquid % as Shdge, % I So 100 OPismpable % DP Pourable % Oirs &G Grease: aN Nona 0>1 100ppm >5%  Odor: Spedlfic Gravity: 008-1.2 9>1.2 a  Os2 091x12.5 04Ge D2lo5 0212.5 5bg D OBODs DCOD: Nltrogen: B NA- 04200ppm 0200102,000ppm a. ppm  Contains Chelating TSCA/PCBS?  Ammonie:. ppm TotelN:. ppma -TKN:, ppm Phenols:  012,000101 10,000ppm Phosphorus: ppm D <5pp.m  Does then materlal contain phthaletes?: DYes QN No Does ther material contain 1,4-Dioxane, PFASPFOS or brorldes?: Yes AI No  lfyes Identify:  .Conc: pon ifyes, Identily:  Ayssfeye Reayelng ! Teuteit    Secuon a a2aihylhaypnhaine 0 Carbazole. On n-Dacane Metals: 04 Antinany DAsanic JBanum DC Cadmar Dg Chromkm. 08 Borzeng Caibon) Tetracnicride: Chioroperzere Do-dresor: Qm-Cresot Op-Crasot OCresc: E14Deherobenzane a Cniordane D Eadrin  INU. JFluorarunene 0248-Tierwurepterol Ow-Ociadecane. opn 3pn ppm'  'UI UIE usu! ppr pa ap: ppn ppm ppm RCRAMelas ppm ppm op ppm. ppm som opm ppm eR ppr ppm PG:  Wastewater Organics: Results below are: Total OTCLP BRL: Handudife) Joltiall here ifallr results botow arer represenied ASE Below Regulatory Lavels  ppn pgn opm DConelt pom' 0o Copper pom' OLead pum' OMercury ppm pom pprr. ppm ppm pom pom ppm ppr pprr nspors npru  C3-Cresa Op-Creso: 023-Dilorpan.ing.  ppm ppm ON Molybdenum CINgsek as Solsnum OSiver ppm cpm ppm ppn ppm pom r  Metal results below; are: OTotal OITCLP BRL: Haudwrilel Initiel! herei ifalie resilis! bolow are represontada as Bolow Regulatory Lovols  OTn OTiamun OVanadim DZng Methyl Etryl* Kelona airachioroineylane OTichiorsthens OViryichonde ONitropenzene. Pentachomphero. OPyridene 0245-Tmememopmarer 0240-Tismeghansi aT Toxaphere 024-0 0145-TPYAL  opm" opny' OChiorolons 312-0smoroethans Ov-penerethylane 024Dmiroiclumns OMarachioroenzene. Oraacheroauacione rpm Orexac-oroathans OHeplachlor undare: Metharyener Shipping Name:  RCRA VOCs: Results below are: Total OTCLP BRL: Handrlte Initial lorel ifall results bolow arer roprosented as Balow Rogulatory Levels RCRA SVOCs: Results below are: OTotal OTCLP BRL: Handwrita Initial horei ifa ailn resulis balovre aror represanted as Below Regulatory Levels  RCRA Herb/Pest Organics: Results below are: OTotal TCLP BRL: Handwrite iniliall here Hallr resulls balow arer represented 4s Bolow Requlatary Levels  N Non-Hazardous, Non- Regulated (add Descripion/mpacted Absorbent and Oil Materiai Solid  OUSDOT Shipping Name: IDN No: Special shipping Instructions: E NA. List: Secdon OCWTV Wastewater Treatment  Hazard Class: dalermtnationst dostredy  eament ONCAOHEALIGON ssuedi are dandliings lanfocuse  OSolldificalion Obrsciedasrain OUsed Oil/Filler Recycling OPCWRecovery  OSeplage Mgt OWaste-o-Energy, (ThirdParly Universal Waste Handling (hird Parly) Composting (ThirdParly) ORichmond Petroleum Soil Bioremediation Compiete soCS) ODrilling Mud Management ODiling Mud Beneficial Use faiiach HDD Supplement) a Direct Landfill (Thrd Party) aUse: as Producl/Commodily DH Hazardous Waste Management (Thai Pany RGRA rEDF, OTSCA PCBI Management (ThirdPerly. TSGA! Facinlyl Noto: Matorinls monaged dirstly or suhsequently atthird partys sites may regulre adftional analytical (esting andfor profilo documontation.  0C Other:  SectienZw Cerliticationg Shemrack Environmantaif Corporstign andjori as theg generator shal bes conductado ani behalfo EH ofs Genecalo Sigrature Rockdale County Fire Department ComparyNama  Icetify wor panalty of law! thvt lama duly authorzeda ogent oft ter materals gorarstoriowrer. and thys document, ail atlachments and supportingn matorinis warep prepaved and prossntodby mes or y drects supervision andi thatthe lo1 thebest oimys knowiadga. der nformaticng proviledis atua. accurakya ando campiste reprosentalimt oft thes wastemstenais tobe prasantedlo evaluationa and managomentby transported, deirveres, tan oregtou aain cenformancev wif tha! Maurat Characterizationl Profiv ands suppodings documeris Wheres Shamrock Erwiermonal dotemines matérieilot bat pan-c conlarming.  Fulisrmore, lagrse ihata arvy wasto matcriais manayed undor anya approval ssuedt by Shariack  pursuent! loihisn reqsstv willbe  costs associalad wths stcrags, nanding arot tanoly rolurno ol the ssterial to goreraiors orfor oinat alarnate andi owurmanagoment of: ther non confoming meteriar  OSOORN Nashtt,5e Prinleds Name chaemau,tackiate File  SDS DAnaytical: allached pliached DAddtional pages aarted  boutky  JHPk  Shamrock Facikties (Follow applicable shipping instructions issued with a profile-specilc approval):  Shamrock Environmental Corporation Greensboro, NC Phone: 800-881-1098 Attn: Sleve Davis/Chris Qyagilato  Aqua Clean Environmental Company, LLC Florida  Phone: 863-644-0665 Attn: Megan Skeen  6106 Corporate Park Drive Browns Summit, NC27214 USEPA ID: NC0000942144  519 Patton Avenue Greensboro, NC27406 U8EPAID.NCD8927732  3210 Whillen! Rd Lakeland, FL3 33811 JSEPA ID: FLR000034033  1008 ISin Street Tampa. FL3 33605  Shamrock. Environmental- Richmond, VA FKA Aqua Ciean Enviroamental. DFy Viginia. LGI DSAI RECO Bictechnpicgy Phore 804-644- -2800 Attn: Sha ane Kasper 710 Hospital Street Rchmend, VA: 23219 USEPAI ID VAR000503250  FER- Oklahoma City, OK Phone: 405-677-4992 Altn: Facllity Manager 11501 S 1-44 Service Rd. Oklahoma City, OK 73173 USEPA ID: OKR000003459 Aqua-Terra Recycling and Treatment- - Oxford, GA Phone: 678-625-4025 Attn: Facllity Manager 710 Moore Street Oxford, GA: 30054 USEPA ID: GAR000010645  SECF ProilePe:94/2023  Page 20i2    Rockdale County Water Sewer To: MILLER ENVIRONMENTAL GRO 56576  Check Number: Date:  068880 08/21/2024 Paid Amount $44,716.77  Invoice Number 10097137  Date  Description  POI Number  07/25/2024 OILSPILLGIEANUP  TOTALS:  $44,716.77  Rockdale County Water Sewer (770)278-7555 POBOX2 289 ÇONYERS, GA3 30012 Pay FortyFourThousand. Seven HundredSixteen Dollars and 77Cents tot the Order of: MILLER ENVIRONMENTAL GROUP INC POE BOX2 23481 NEWY YORK, NY1 10087  United Community Bank 1000 GAH Hwy 138SE Conyers, GA3 30013 13.  068880 061112843 AMOUNT $44,716.77  DATE Aug 21, 2024  Rockdale County Water Sewer (770)278-7555 POBOX289 CONYERS, GA: 30012  MILLER ENVIRONMENTAL GROUP INC  PO BOX: 23481 NEW) YORK, NY: 10087