Attachment A_AMLD-4783-Chemical Use Request (copy).pdf
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- Attached to
- Spray Insulation Foam Services
- Solicitation number
- W911N226QABB1
About this file
AMLD Form 4783 is a Contractor/Tenant Chemical Use Request form used by Letterkenny Army Depot (LEAD) to manage and control chemical usage by contractors and tenants working on the installation. The form must be completed by contractors before any chemicals are brought onto LEAD, and serves as a compliance document for the Contracting Officer's Representative (COR) to provide to contractors as part of contract requirements.
The form requires contractors to list all chemicals to be brought into work areas, providing specific information including chemical name and manufacturer, flash-point rating, quantity ordered, and description of application methods. Contractors must submit current Safety Data Sheet (SDS) documentation for all listed chemicals to ensure compliance. The form includes acknowledgment sections for review and comments from five key LEAD departments: Area Supervisor/POC, Industrial Hygiene, Fire Prevention, Safety Office, and Environmental Management. Contractors are obligated to comply with all acknowledgment comments provided by these departments. Page 2 of the form provides a table with multiple rows for chemical entries, allowing contractors to either complete the form directly or attach a supplementary spreadsheet containing the required chemical information.
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Text version
Contractor/Tenant Chemical Use Request
AMLD FORM 4783 (DEC 2025) Page 1
Proponent Phone Number POC Comments
Area Supervisor/POC
Industrial Hygiene
Fire Prevention
Safety Office
Environmental Management
1. The COR will provide this form to the contractor for completion as part of the contract. This form must be completed before chemicals are brought onto LEAD by a contractor.
2. The contractor will use page 2 of this form (or attach a spreadsheet that includes the information on page 2) to list all chemicals to be brought into any area where they are contracted to perform work for Letterkenny Army Depot and its proponents.
3. The contractor will submit current SDS documentation for all chemicals listed on page 2 (or the attached spreadsheet) in order to be compliant with the request.
4. The contractor will comply with the acknowledgement comments provided on this form by Industrial Hygiene, Fire Prevention, Safety, and Environmental Management.
Project Name/Contract #:
Contractor/Tenant Chemical Use Request
AMLD FORM 4783 (DEC 2025) Page 2
Chemical Name and Manufacturer Flash-point Qty Ordered Description of Application Methods
File details come from the government source that posted it. Updated .