Attachment 5 - HazMat Authorization Request.pdf
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- Solicitation number
- FA461326R0003
About this file
This is a Hazardous Materials Authorization Request form for F.E. Warren Air Force Base. The form is designed for contractors to request approval for hazardous materials (HAZMAT) to be used or stored on base during construction projects. Contractors must complete the form with their company information, project details, contract timeline, and specific contact information for both their organization and the F.E. Warren AFB project manager and construction management representative. The form requires submission of the manufacturer's Safety Data Sheet (SDS) for every hazardous material being requested, with the option to submit complete SDSs in lieu of completing the HAZMAT information table.
The HAZMAT information table requires contractors to document the material name, manufacturer, product part number, container type and size, paint color or sheen (where applicable), and the projected quantity to be stored on-site. The form includes an example entry for Rust-oleum Stops Rust Enamel Top Coat (part number 7779830) in 12-ounce aerosol cans with gloss black finish, with a projected on-site storage quantity of 35 units. The table provides multiple blank rows for contractors to list additional hazardous materials as needed for their specific project requirements.
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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.
File details come from the government source that posted it. Updated .