Attach 7_HazMat Authorization Request.pdf
PDF 1 MB Posted
- Attached to
- PKAA Dorm Carpet BLD 222, 223 & 226 (Service)
- Solicitation number
- FA461326Q0013
About this file
This is a Hazardous Materials Authorization Request form for F.E. Warren Air Force Base. The form is used to request approval for hazardous materials (HAZMAT) storage and use on military installation projects. Contractors must submit this form along with manufacturer Safety Data Sheets (SDS) for each hazardous material being requested.
The example provided documents a request for Rust-Oleum Stops Rust Enamel Top Coat (Product Part #7779830) for the project "Replace Carpet in Dorm Room Bldgs. 222, 223, 226" under Contract Number GHLN 26-7302. The material specifications include 12 oz aerosol cans in gloss black with a projected on-site storage quantity of 35 units. The form requires the contractor to provide basic information including contractor name, point of contact, phone number, project details, contract dates, project location, and the F.E. Warren AFB point of contact (Shaela Kendall, 307-773-2161) and construction management representative. The HAZMAT information table requests material name, manufacturer, product part number, container type and size, paint color/sheen, and projected quantity stored on-site. Submission of complete SDS documentation for all requested hazardous materials is mandatory.
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Text version
HAZARDOUS MATERIALS AUTHORIZATION REQUEST
Contractor Name: _________________________________________________________
POC: ______________________________________ Phone: ______________________
Project Name: ____________________________________________________________
Project/Contract Number: _________________________________________________
Contract Start Date/period: ___________________ End Date: ________________
Location of Project: _____________________________________________________
F.E. Warren AFB POC: _______________________________ Phone: ______________
Construction Mgmt Rep: _____________________________ Phone: ______________
HAZMAT Information
Material Name Manufacturer
P r o d u c t
P a r
C o n t a i n e r
T y p
S i z a i n
C o l o h e o j e c t d
Q u a n t i y o r d
O
S i
Rust-oleum Stops Rust Enamel Top Coat
Rust-Oleum 7779830 12 oz Aerosol can
Gloss Black
Submission of this form must be accompanied by a copy of the Manufacturer’s SDS for every HAZMAT requested. SDSs including all information requested below may be submitted in lieu of completing the HAZMAT information table below.
1249253797C Typewritten Text Replace Carpet in Dorm Room Bldgs. 222, 223, 226
1249253797C Typewritten Text
GHLN 26-7302
1249253797C Typewritten Text Bldgs. 222, 223, 226
1249253797C Typewritten Text Shaela Kendall
1249253797C Typewritten Text 307-773-2161
File details come from the government source that posted it. Updated .