09 FA489725B0008 Contractor HAZMAT Reporting Form.pdf
PDF 39 KB Posted
- Attached to
- Repair Building 1330 Main Sewage Line
- Solicitation number
- FA489725B0008
About this file
The document is a Contractor's Hazardous Materials Reporting Form for Mountain Home Air Force Base (MHAFB), specifically related to the FA489725B0008 contract for repairing the main sewage line in Building 1330. The form requires contractors to comprehensively document all hazardous materials to be used during the project, including manufacturer details, product descriptions, container types, sizes, and projected total quantities. Each hazardous material entry must be accompanied by a manufacturer-specific Material Safety Data Sheet (MSDS).
The form provides detailed instructions for completion, requiring contractors to specify company information, project name, contract number, on-site project contact, government Quality Assurance Evaluator (QAE) details, HAZMART account number, and project location. Container sizes should be reported in preferred units of ounces, with additional measurement options including pounds, gallons, pints, quarts, liters, and kilograms. Contractors can contact the 366 FW A6 7/A7IE Hazardous Materials Program Manager or HAZMART Pharmacy for guidance, with contact numbers provided on the instruction page.
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Text version
MHAFB Contractor’s Hazardous Materials Reporting Form
1. Company Information
2. Project Name/Govt Contract Number
3. Contract Start/End Dates
4. Submission Date
5. On-site Project POC Name/Cell Phone # 6. Govt QAE Name/Phone # 7. HAZMART Account #
8. Project On-Base Location
9. Manufacturer and Product Name/Description
(ex: Sherwin Williams gloss white latex paint)
10. NSN/Part #/ID #
(if applicable)
11. Container Type (can, tube, drum, bag, etc)
12. Container Size (LB, OZ, GL,PT,QT, LT, KG )
13.
Projected Total Quantity
Page_____ of _____
MHAFB Contractors Hazardous Materials Reporting Form
- Continuation Sheet -
1. Company Information
2. Project Name/Govt Contract Number
3. HAZMART
Account Number
4. Submission Date
9. Manufacturer and Product Name/Description
(ex: Sherwin Williams gloss white paint)
10. NSN/Part #/ID #
(if applicable)
11. Container Type (can, tube, drum, bag, etc)
12. Container Size (LB, OZ, GL,PT,QT, LT, KG )
13. Projected Total Quantity
Page_____ of _____
MHAFB CONTRACTOR’S HAZARDOUS MATERIALS REPORTING FORM INSTRUCTIONS
1. Company name, address and telephone number.
2. Project name or identifying description and government contract number.
3. As written.
4. Date that this form was submitted to the QAE or HAZMART.
5. Name and phone, or cell number of the contractor’s on-site project manager, foremen, or contact person.
6. Name and phone, or cell number of government Quality Assurance Evaluator (QAE) assigned to the project.
7. HAZMART account number – assigned by the HAZMART once an account is established for this project.
8. Location, or nearest location or building number where the actual work is to take place.
9. Manufacturer’s name and product description of the hazardous material being reported.
10. National Stock Number (NSN) from MSDS, part number, or a number or code identifying the container or material.
11. As written.
12. Container sizes for the product reported: LB = pound, OZ = ounce, GL = gallons, PT = pint, QT = quart, LT = liter, KG = kilogram. Ounces is the most preferred.
13. Known or projected total quantity or amount of this material expected to be used in this project.
Additional Information
A manufacturer-specific Material Safety Data Sheet (MSDS) is required for each item listed on this form and must be turned in with this form.
For additional guidance, refer to the MHAFB HAZMAT Monitor’s Handbook available from 366 FW A6 7/A7IE HAZMAT Manager, at COM: (208) 828-1684, or DSN: 728-1684.
Contact Information
366 FW A6 7/A7IE Hazardous Materials Program Manager Cory Mikita (208) 828-1684
HAZMART Pharmacy Michael Szafranski (208) 828-2360/2690
| MHAFB Contractor’s Hazardous Materials Reporting Form |
| MHAFB Contractors Hazardous Materials Reporting Form |
File details come from the government source that posted it. Updated .