Attachment 3_Contractor Hazardous Material Inventory.pdf

CONTRACTOR HAZARDOUS MATERIAL INVENTORY (CHMI)

Ref: NAVSEA Standard Items 009-97 and 009-02

NWRMC Local Standard Item 099-04NW Document No.

CONTRACTOR – INITIAL REQUEST1 (Before moving any hazmat onto this Federal facility) **Refer to instructions on last page** Page of

PRIME CONTRACTOR (KTR) (POC) SUB-CONTRACTOR (If Applicable) PRIME KTR CERTIFICATION SIGNATURE (sign or submit electronically) Print & sign

PHONE

CONTRACT NUMBER PROJECT NAME

WORKSITE LOCATION

PROJECT EXECUTION START DATE PROJECTED END5

ENVIRONMENTAL, SAFETY, AND HEALTH (ESH) GOVERNMENT REPRESENTATIVE

CONTRACT OFFICE AGENCY (i.e., C/400, AIT) ESH GOVERNMENT REPRESENTATIVE NAME PHONE FAX SUBMITTAL DATE

CODE 106.31 HAZARDOUS MATERIAL PROCESS MANAGEMENT BRANCH

106.31 NAME & INITIALS RECEIPT DATE REVIEW DATE

Trade Name

Name on product & SDS must match

For kits, list kit name, then list kit components individually

Manufacturer

Process Code Number

Use provided flow chart

Container Size & Type

Enter size

PSNS & IMF 5090/132 (Rev. 10-17)

CONTRACTOR HAZARDOUS MATERIAL INVENTORY (CHMI)

CODE 106.31 Document No. Page of

CONTRACTOR – INITIAL REQUEST (Before moving any hazmat onto this Federal facility)

Trade Name

For kits, list kit name, then list kit components individually

Manufacturer

Process Code Number

Use provided flow chart

Container Size & Type

Enter size

PSNS & IMF 5090/132 (Rev. 10-17)

INSTRUCTIONS

Contractor: Fill out each section under the heading “CONTRACTOR” per the following instructions and footnotes. List all hazardous material (HM) that you, as the contractor, anticipate transporting from offsite onto the Federal property located at the Bremerton Naval Complex (BNC). Do not list HM obtained inside the BNC that has been labeled with the facility’s salmon colored supplemental barcode label. Use as many additional sheets as necessary to include all HM that you anticipate transporting onsite. Provide the most current SDS for each product listed in the CHMI. If you are using a “Non-Road” engine do not forget to submit an O&M plan to Code 106.31 Air Department. For all marine coatings, provide a Volatile Organic Compound (VOC) certification sheet for each batch. If you have a Marine Coating that is General Use and the VOC’s are above 340g/l you must submit separate paperwork to Code 106.31 Air department Via a Low Use Exempt Form. All HM must be approved by the Code 106.33 before bringing material onsite. Upon completion of all Contractors required items submit the completed CHMI form to your Government Environmental, Safety, and Health representative.

* Prime Contractor Certification Statement: I hereby certify that the submitted information contained in the attached document(s) is true, complete and accurate, and all material listed has been approved by Code 106.33.

Designated Government Environmental, Safety, and Health Representative: Complete Designated Government ESH section. Submit completed CHMI to Code

106.33 for review and approval.

FOOTNOTES

1. This is for the initial request. Use the Receipt & Monthly Usage Form to report monthly HM usage by the 5th calendar day of the following month.

Negative usage reports are required. If no usage, enter 0 in applicable field or leave blank and submit report.

2. Identify Project (e.g. – ship hull number or name, bldg. 431 5th floor, Dry Dock 2, Pier D, etc).

3. Identify Worksite Location (PSNS or NBK).

4. The date that the contractor is to start work on the project.

5. The planned (best estimation) completion date for work on the project.

6. Provide a separate line for each product and/or container size that will be used. When reporting kits, list each component on separate lines. If part numbers are included in the Trade Name block, it will be helpful in processing the CHMI faster.

Reference example below.

Trade Name Manufacturer Container

Size & Type

SYNDECK BOND COAT Part A SA1222 EPMAR Corp 0.8 gal CN

SYNDECK BOND COAT Part B SB1222 EPMAR Corp 0.2 gal CN

SYNDECK BOND COAT Part B SC1222 EPMAR Corp 10lb

Table 1 – Container Type

Description Aerosol Can

Bag Bottle Box Cartridge Can Container Cylinder Drum

Code AER BG BT BX CA CN CO CY DR

Description Each Jar Package Kit Rod Spool Tank Tube

Code EA JR PG KT RD SP TK TU

7. Manufacturer, product name and company name on container and on the SDS must all match what is put on the CHMI.

8. To determine the proper Process Code Number use the attached Hazardous Material Process Code Selection Flow Chart.

9. Report container size(s) in quantifiable units (e.g., weight or volume) such as a 3 lb. jar or a 16 fl oz bottle. For compressed gas cylinders, report the quantity of gas in cubic feet or units such as pounds (e.g., 150 cu-ft or 100 lb cylinder). For bulk material (e.g., diesel fuel) or material without a specific container size (e.g., welding rod or wire), use the units in which the material is commonly sold to consumers (e.g., use gallon for diesel fuel or pound for welding rod or wire). For kits, list both the kit size and each individual component size. Reference Footnote 6 for reporting kits. See Table 1 for the applicable container type. Enter container type code.

10. For Usage remember you are reporting for the size requested and it is listed on the form. When reporting round up to the nearest tenth, use percentages (i.e. do not use: 3 gal of a 10 gal container, use: .3

When Reporting Partial Usage, Use Decimals to Represent the Fraction of Container Used.

EXAMPLE:

Use 0.8 to indicate 3/4 usage of a container Do Not Enter as Lbs, Gallons, Ounces etc.

Round Up to Nearest Tenth.

Use 0.3 to indicate 1/4 usage of a container Use 0.8 to indicate 3/4 usage of a container

PSNS 5090/132 (Rev. 10-15)