Attachment 4 Hazmat Auth Request (Post Award).pdf

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Attached to
Decommission Missile Alert Field (MAF) R-01 Radio Tower and Generator AMENDMENT 01
Solicitation number
FA461326Q0002
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About this file

This is a Hazardous Materials Authorization Request form (Section 01 57 19.05 32, Attachment 1) used for federal construction contracts at F.E. Warren Air Force Base. The form documents the contractor's request to use hazardous materials on-site and requires submission of manufacturer Safety Data Sheets (SDS) for all requested materials. The form captures essential information including contractor identification, project details, F.E. Warren AFB points of contact, and a detailed HAZMAT information table specifying material name, manufacturer, product part number, container type and size, paint color/sheen, and projected quantity stored on-site.

The document provides a specific example entry for the "Decommission Romero 01 Tower & Genset package" project (Contract Number GHLN 25-2741[OPP1152741 (WT16455021)]) located at Romero 01. The contractor is authorized to store 35 twelve-ounce aerosol cans of Rust-Oleum Stops Rust Enamel Top Coat (Product #7779830) in Gloss Black finish. The F.E. Warren AFB POC is Fotios Papadopoulos (773-3379) and the Construction Management Representative is Carla J. Mlinar (773-3574). Contractors may submit complete SDS documentation in lieu of completing the HAZMAT information table.

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Text version

Environmental Protection Section 01 57 19.05 32 Page 32

SECTION 01 57 19.05 32

ATTACHMENT 1

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.

Contractor Name:
POC:
Phone:
Project Name: Decommission Romero 01 Tower & Genset package
ProjectContract Number: GHLN 25-2741[OPP1152741 (WT16455021)]
Location of Project: Romeo 01
FE Warren AFB POC: Fotios Papadopoulos
Phone_2: 773-3379
Construction Mgmt Rep: Carla J. Mlinar
Phone_3: 773-3574
Rustoleum Stops Rust Enamel Top CoatRow1:
RustOleumRow1:
7779830Row1:
12 oz Aerosol CanRow1:
Gloss BlackRow1:
35Row1:
Rustoleum Stops Rust Enamel Top CoatRow2:
RustOleumRow2:
7779830Row2:
12 oz Aerosol CanRow2:
Gloss BlackRow2:
35Row2:
Rustoleum Stops Rust Enamel Top CoatRow3:
RustOleumRow3:
7779830Row3:
12 oz Aerosol CanRow3:
Gloss BlackRow3:
35Row3:
Rustoleum Stops Rust Enamel Top CoatRow4:
RustOleumRow4:
7779830Row4:
12 oz Aerosol CanRow4:
Gloss BlackRow4:
35Row4:
Rustoleum Stops Rust Enamel Top CoatRow5:
RustOleumRow5:
7779830Row5:
12 oz Aerosol CanRow5:
Gloss BlackRow5:
35Row5:
Rustoleum Stops Rust Enamel Top CoatRow6:
RustOleumRow6:
7779830Row6:
12 oz Aerosol CanRow6:
Gloss BlackRow6:
35Row6:
Contract Start Dateperiod:
Contract End Dateperiod:

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