Attch_5_-_Haz_Waste_Form.doc

FORECAST OF CONTRACTOR’S HAZARDOUS WASTE GENERATION

DELIVERY ORDER

CONTRACTOR:

POINT OF CONTACT:

PHONE:

FAX:

(INCLUDE METHOD OF APPLICATION)

Purpose: The Forecast of Contractor’s Hazardous Waste Generation is required to assist the installation to identify processes using hazardous materials and regulate the generation and disposal of hazardous waste.

Instructions: The Forecast of Contractor’s Hazardous Waste Generation form must be completed by any contractor who:

1) Must remove and dispose of paints, building components, or equiptment containing hazardous materials (lead, mercury, etc.)

2) Submits an MSDS for approval of use of a material known to be hazardous.

On multi contractor projects, each contractor (sub-contractor) must specify each process requiring the use of hazardous materials and the potential waste to be generated.

1. Project #: Provide installation project number.

2. Project Title: Provide installation project title.

3. Contractor: Enter complete name of contractor performing process.

4. Point of Contact: Provide name of individual knowledgable on requirements of materials listed.

5. Phone/Fax: Provide phone and fax numbers for point of contact.

6. Hazardous Material: Provide common name of each hazardous material

7. Description of Process(es) Requiring Material: Describe each process in which the material will be used (Thinning paint, cleaning tools, etc.). Describe methods of application where appropriate (applied to rag, sprayed gun, etc.).

8. Description of Waste: Provide description of anticipated waste stream or enter “none” if no waste is anticipated to be generated.

9. Quantity: Estimate quantity of waste to be generated

10. Sign and date each form at bottom

CONTRACTOR’S SIGNATURE ______________________________________ DATE ________________