Attachment 4- Environmental Hazardous Material Use.pdf
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- Solicitation number
- FA462025QA911
About this file
This document is a Contractor Hazardous Material Authorization and Use form for Fairchild Air Force Base, dated 30 April 2018, associated with the FA462025QA911 solicitation for Sewer Cleaning and Inspection Services. The form is a comprehensive template designed to track and report the use of hazardous materials by contractors working on the base, requiring detailed documentation of each hazardous substance including product name, manufacturer, physical state, container amount, maximum on-site quantity, estimated and actual amounts used, and specific process type.
The form includes an extensive Table 1 listing 32 different process type codes ranging from asbestos removal and adhesive applications to various surface coating and welding processes. Contractors must complete the form with precise details about each hazardous material, attach corresponding Material Safety Data Sheets (MSDS), and report usage either monthly or at contract end. The document emphasizes safety protocols by requiring contractors to specify whether Air Force or Civil Service personnel will be exposed to the chemicals, and provides a structured approach for tracking and managing hazardous material use during the project at Fairchild Air Force Base.
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Text version
Attachment 4
FA462025QA911
FAIRCHILD AIR FORCE BASE DESIGN STANDARDS 30 April 2018
CONTRACTOR HAZARDOUS MATERIAL AUTHORIZATION AND USE
1. PRIME CONTRACTOR/ORGANIZATION: 2. E-MAIL 3. PHONE 4. FAX 5. DATE
6. PRIME COTR/POC 7. PHONE 8. FAX 9. CONTRACT NUMBER
10. CONTRACTOR/ORGANIZATION POC 11. WORKPLACE/BLDG 112. SUB-CONTRACTOR
I
13. DELIVERY ORDER
14. CONTRACTING OFFICER/FAFB QPR 15. CONTRACTING OFFICER SIGNATURE
19. OFFICE REQUESTING CONTRACT/QPR 20. SIGNATURE
24. EXPECTED START DATE
25. EXPECTED END DATE
27. Will Air Force or Civil Service Personnel be exposed to these chemicals?
Product Name/Part Number Material Manufacturer 2 Solid, Amount Contai
Liquid & Unit of ner or Gas lssue
4 Type
FOOTNOTES:
1. This form is used for initial approval of hazardous materials and to report subsequent usage.
2.
3.
Include all materials, which contain an EHS, TRI, CERCLA hazardous substance, toxic chemical, generates a hazardous waste after use, and/or requires a Material Safety Data Sheet.
Attach copy of MSDS for each line item.
Identify National Stock Number if known. If unknown, leave blank, and HMMP will complete.
DIVISION 01-GENERAL REQUIREMENTS
SECTION 013543
16.PHONE 17.FAX 18.DATE
21. PHONE 22.FAX 23.DATE
26. PROJECT/TASK DESCRIPTION
Max Est. Actual Process Remarks/Notes
Amount Amount Amount Onsite at Used for Used
Type any Time 5 Project
4.
5.
6.
7.
8.
Identify amount in container & the units item is measured in, i.e. gallon, ounces, lbs, etc.
Identify maximum amount present (stored and used) at any one time on Fairhcild AFB.
Report actual quantities used at the end of the project, by January if project extends beyond Calendar Year, and/or when directed on reporting schedule on reverse (Block 27) See Table 1-Process Types for appropriate codes.
Use the Remarks/Notes section to indicate specific process/product information, e.g. weight of each component in a kit, mix rations, disposal info, etc.) Government will also use this section to indicate authorization status.
ATTACHMENT
FAIRCHILD AIR FORCE BASE DESIGN STANDARDS
Attachment 4
FA462025QA911
CONTRACTOR HAZARDOUS MATERIAL AUTHORIZATION AND USE
Product Name/Part Number Material Manufacturer 2 Solid, Amount Contai Max Est. Actual Process Remarks/Notes
Liquid, & Unit ner Amount Amount Amount Type or Gas of Type Onsite at Used for Used lssue any Time 5 Project
28. Usage Reporting Schedule TABLE 1-PROCESS TYPES
□ Monthly I D End of Contract CODE PROCESS DESCRIPTION CODE PROCESS DESCRIPTION
A Asbestos removal and disposal R Fiberglass or composite applications COMMENTS:
B Asphalt paving s Renovation, specify process
C Abrasive blasting; specify substrate, blast media T Stationary internal combustion engines, gasoline; specify size, gallons of fuel
DIVISION 01-GENERAL REQUIREMENTS
SECTION 013543
D
E
F
G
H
I
J
K
L
M
N p
Q and surface area cleaned
Adhesives
Brazing
Chemical or physical analysis
Cutting, oxy-fuel; specify substrate
Cutting, plasma arc; specify substrate
Cutting, mechanical process, specify substrate
Construction, specify process
Demolition, specify process
Degreasing operations using solvents
Fuel combustion
Grinding, specify substrate and surface area
Industrial boiler operations
Natural gas combustion
Paint stripping, chemical u
V w
X y z
AA
BB
cc
DD
EE
FF
GG
HH
burned, & hours of operation
Stationary internal combustion engines, diesel; specify size, gallons of fuel burned, & hours of operation
Sanding, specify substrate and surface area sanded
Surface coating, brush or roller applications
Surface coating, spray applications in filtered enclosures
Surface coating, HVLP spray applications in filtered enclosures
Surface coating, airless spray applications in filtered enclosures
Surface coating, electrostatic spray applications in filtered enclosures
Surface coating, thermal spray applications n filtered enclosures
Surface coating, spray applications outdoors
Surface coating, HVLP spray applications outdoors
Surface coating, airless spray applications outdoors
Welding, oxy-fuel; specify substrate and filler material
Welding, electric arc; specify substrate and filler material
Soldering, specify substrate and filler material
ATTACHMENT
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