1Cix Hazmat Usage Log.pdf

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Repair Overruns on Center Runway
Solicitation number
FA309921R0002
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LAUGHLIN AFB SHORT-TERM CONTRACTOR HAZMAT USAGE LOG

Contract number:

Contractor: Month/Year:

PRODUCT NAME PART

NUMBER MANUFACTURER

QTY

USED

(GALS OR

LBS)

APPLICATION

METHOD (BRUSH,

ROLLER, SPRAY,

RAG, OTHER)

Complete log and submit to the Contracting Officer at the completion of your contract or at the end the month, whichever comes first. If your contract spans multiple months, submit log at the end of each month.

Contract number:
Contractor:
MonthYear:
PRODUCT NAMERow1:
PART NUMBERRow1:
MANUFACTURERRow1:
QTY USED GALS OR LBSRow1:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow1:
PRODUCT NAMERow2:
PART NUMBERRow2:
MANUFACTURERRow2:
QTY USED GALS OR LBSRow2:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow2:
PRODUCT NAMERow3:
PART NUMBERRow3:
MANUFACTURERRow3:
QTY USED GALS OR LBSRow3:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow3:
PRODUCT NAMERow4:
PART NUMBERRow4:
MANUFACTURERRow4:
QTY USED GALS OR LBSRow4:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow4:
PRODUCT NAMERow5:
PART NUMBERRow5:
MANUFACTURERRow5:
QTY USED GALS OR LBSRow5:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow5:
PRODUCT NAMERow6:
PART NUMBERRow6:
MANUFACTURERRow6:
QTY USED GALS OR LBSRow6:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow6:
PRODUCT NAMERow7:
PART NUMBERRow7:
MANUFACTURERRow7:
QTY USED GALS OR LBSRow7:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow7:
PRODUCT NAMERow8:
PART NUMBERRow8:
MANUFACTURERRow8:
QTY USED GALS OR LBSRow8:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow8:
PRODUCT NAMERow9:
PART NUMBERRow9:
MANUFACTURERRow9:
QTY USED GALS OR LBSRow9:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow9:
PRODUCT NAMERow10:
PART NUMBERRow10:
MANUFACTURERRow10:
QTY USED GALS OR LBSRow10:
APPLICATION METHOD BRUSH ROLLER SPRAY RAG OTHERRow10:

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