Atch 5. PWS Appx E Hazardous Materials Form.pdf

PDF 3 MB Posted Jun 30, 2020

Attached to: Automatic Doors Repair and Maintenance Federal contract opportunity
Solicitation number: FA4855-20-Q-0012
Issued by: Department of the Air Force Special Operations Command

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Other files for this federal contract opportunity

Other files attached to Automatic Doors Repair and Maintenance, newest first.
File	Type	Posted
Atch 1. Instructions to Offerors and Basis of Award 30 June 2020.pdf	PDF	Jun 30, 2020
Atch 6. Provisions and Clauses.pdf	PDF	Jun 30, 2020
Atch 2. Pricing Worksheet.pdf	PDF	Jun 30, 2020
Atch 3. Performance Work Statement (Includes Appx A-C).pdf	PDF	Jun 30, 2020
Atch 7. Wage Determination 2015-5458 Rev 13.pdf	PDF	Jun 30, 2020
FA485520Q0012 Combo 30 June 2020.pdf	PDF	Jun 30, 2020
Atch 4. PWS Appx D Environmental Guide.pdf	PDF	Jun 30, 2020

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ATTACHMENT 1

CAFB & MAFR Contractor

HAZMAT Worksheet

1. Contractor Information

Contractor Name:

Contract Number:

Project Number:

Estimated Start Date:

Estimated Completion Date:

Assigned Shop Code, if known:

2. Material Information

Material Name (from SDS):

Material Stock No. (MSN), or National Stock No.

(NSN), or Local Stock No. (LSN), enter if known:

Container Type (check one):

Box

Bag Tube

Bottle Can

Drum

Container Volume or Weight (check one):

Weight Oz. GramsPounds Tons

Quarts

Gallons

Other(Specify):

Total No. of Containers: Container Size: Total HAZMAT

Quantity:

3. Process Information

Process Type:

Process Description:

4. Engine ering

Describe process engineering controls:

5. Personal Protective Equipment (PPE)

Describe process PPE:

6. Location Information

Process will be performed on/at (check all that apply):

Existing Facility Aircraft Outdoors

E quipment New Facility

Other (Specify):

Physical location of process:

Staging location of HAZMAT:

Other (Specify)

Kilograms Fluid Oz Pints

Cartridge

ATTACHMENT A-1

Cannon AFB & Melrose AFR

Contractor HAZMAT

IAW FAR 52.223-3/AFI 32-7086 3.4.1; All HAZMAT brought onto an installation for use shall be authorized via the process described in this section.

NOTE: Manufacturer’s Safety Data Sheet (SDS) is required for every worksheet

The information submitted is complete. The HAZMAT noted above may enter Cannon AFB and/or Melrose AFR

The information submitted is incomplete and/or erroneous. Please follow the instruction below and resubmit.

7. Additional Information

Will a hazardous waste be generated (circle one)?

Yes No TBD Describe method(s) of waste management, transport, and disposal:

8. Contractor Signature Block

Title Phone Number

Printed Name Date

Signature

9. Environmental Approval Signature Block

Title Phone Number

Printed Name Date

Signature

ATTACHMENT 2

CAFB & MAFR Contractor HAZMAT Usage

Worksheet

1. Project Information

Contractor Name:

Contract Number: Project Number:

Project Location: Shop Code (if known):

Project Start Date: This worksheet is required monthly on the 5th for project is >60 days, and projects <60 Days, once at the projects end.

Project Est. End Date:

2. Reporting Information

Reporting Date:

Name:

3. Material Usage

HAZMAT Name (SDS) MSN Container Size

(w/ Unit of Measure) Containers Used

This Period

Estimated Start Date:

Estimated Completion Date:

Assigned Shop Code if known:

Material Name from SDS:

Material Stock No MSN or National Stock No NSN or Local Stock No LSN enter if known:

Weight Oz Pounds Tons Grams Kilograms Fluid Oz Pints Quarts Gallons Other SpecifyTotal No of Containers:

Container Size:

Total HAZMAT Quantity:

Process Type:

Process Description:

Describe process engineering controls:

Describe process PPE:

Other Specify:

Describe methods of waste management transport and disposal:

Title:

Phone Number:

Printed Name:

Date:

Title_2:

Phone Number_2:

Printed Name_2:

Date_2:

Specify:

Location:

Staging location of HAZMAT:

Group11: Off

Group12: Off

Group13: Off

Clear Form:

Group4: Off

Check Box1: Off

Dropdown9: [N/A]

Text10:

Check Box11: Off

Contractor Name:

Contract Number:

Project Number:

Project Location:

Shop Code:

Project Start Date:

Project Est End Date:

Reporting Date:

Name:

HAZMAT Name SDSRow1:

MSNRow1:

Container Size w Unit of MeasureRow1:

Containers Used This PeriodRow1:

HAZMAT Name SDSRow2:

MSNRow2:

Container Size w Unit of MeasureRow2:

Containers Used This PeriodRow2:

HAZMAT Name SDSRow3:

MSNRow3:

Container Size w Unit of MeasureRow3:

Containers Used This PeriodRow3:

HAZMAT Name SDSRow4:

MSNRow4:

Container Size w Unit of MeasureRow4:

Containers Used This PeriodRow4:

HAZMAT Name SDSRow5:

MSNRow5:

Container Size w Unit of MeasureRow5:

Containers Used This PeriodRow5:

HAZMAT Name SDSRow6:

MSNRow6:

Container Size w Unit of MeasureRow6:

Containers Used This PeriodRow6:

HAZMAT Name SDSRow7:

MSNRow7:

Container Size w Unit of MeasureRow7:

Containers Used This PeriodRow7:

HAZMAT Name SDSRow8:

MSNRow8:

Container Size w Unit of MeasureRow8:

Containers Used This PeriodRow8:

HAZMAT Name SDSRow9:

MSNRow9:

Container Size w Unit of MeasureRow9:

Containers Used This PeriodRow9:

HAZMAT Name SDSRow10:

MSNRow10:

Container Size w Unit of MeasureRow10:

Containers Used This PeriodRow10:

HAZMAT Name SDSRow11:

MSNRow11:

Container Size w Unit of MeasureRow11:

Containers Used This PeriodRow11:

HAZMAT Name SDSRow12:

MSNRow12:

Container Size w Unit of MeasureRow12:

Containers Used This PeriodRow12:

HAZMAT Name SDSRow13:

MSNRow13:

Container Size w Unit of MeasureRow13:

Containers Used This PeriodRow13:

HAZMAT Name SDSRow14:

MSNRow14:

Container Size w Unit of MeasureRow14:

Containers Used This PeriodRow14:

HAZMAT Name SDSRow15:

MSNRow15:

Container Size w Unit of MeasureRow15:

Containers Used This PeriodRow15:

HAZMAT Name SDSRow16:

MSNRow16:

Container Size w Unit of MeasureRow16:

Containers Used This PeriodRow16:

HAZMAT Name SDSRow17:

MSNRow17:

Container Size w Unit of MeasureRow17:

Containers Used This PeriodRow17:

HAZMAT Name SDSRow18:

MSNRow18:

Container Size w Unit of MeasureRow18:

Containers Used This PeriodRow18:

HAZMAT Name SDSRow19:

MSNRow19:

Container Size w Unit of MeasureRow19:

Containers Used This PeriodRow19:

HAZMAT Name SDSRow20:

MSNRow20:

Container Size w Unit of MeasureRow20:

Containers Used This PeriodRow20:

File details come from the government source that posted it. Updated Jun 30, 2020.