Attachment E MFG_Waste_Evaluation_Form.docx

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6550--5 year single award Indefinite Quantity-Indefinite Delivery contract for CPRR Clinical Laboratory Coagulation Instrumentation
Solicitation number
36C26321Q0102
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36C26321Q0102 A0001.pdf PDF
Attachments A - C - Template for Vendors UPDATED.xlsx XLSX spreadsheet
QA.pdf PDF
36C26321Q0102 A0001_1.docx DOCX document
36C26321Q0102.pdf PDF
Attachments A - C - Template for Vendors.xlsx XLSX spreadsheet
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Attachment A: Chemical Evaluation Form Manufactures Name: _____________________________________________

References F-list: http://www.pca.state.mn.us/publications/w-hw2-00.pdf P-list: http://www.pca.state.mn.us/publications/w-hw2-02.pdf U-list: http://www.pca.state.mn.us/publications/w-hw2-03.pdf Characteristic waste: http://www.pca.state.mn.us/publications/w-hw1-01.pdf Hazard Info: hHttp://www.pca.state.mn.us/publications/w-hw2-01.pdf

Product as Manufactured

On MN Hazardous Waste List? Yes or No

Product Number
Product or Kit Name
CAS or RCRA Code
F-List
P-List
U-List
Hazardous Characteristic: C = Corrosive; I = Ignitable; L = Lethal; O = Oxidizer; R = Reactive; T = Toxic
Quantity of mercury, lead or barium in PPM or mercury containing preservatives like thimerosol.

Does this product contain Phosphorus or will it contribute to the total Phosphorus concentration in waste water.

Yes or No

Concentration and Name of Hazardous Chemical
PH
Is there

> 50ppm Poly-chlorinated Biphenyls

Is the mercury cell process used during production of this reagent/chemical
Disposal of used or partially used product: I = Infectious/Biohaz; F = Flammable Hazard; H = Hazardous; R = Recycle; S = Sewer; T = Regular Trash
Disposal of Reagents after consumption by instrument: I = Infectious/Biohazard; F = Flammable Hazard; H = Hazardous; R = Recycle; S = Sewer; T = Regular Trash
Quantity per bottle.
% Sewered by instrument if applicable.

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