01400 New 2009 Environmental Protection.doc

Base Pavements IDIQ

JCGU 09-1700

DIVISION 1 - GENERAL REQUIREMENTS

SECTION 01400 - ENVIRONMENTAL PROTECTION

1. APPLICABLE ENVIRONMENTAL REGULATIONS, LAWS, AND PUBLICATIONS: The publications listed below form a part of this specification to the extent referenced. The publications are referred to in the text by basic designation only. All publications shall be the latest version/edition/revision of the documents listed below, in effect on the date of this solicitation, except where a date is given.

1.1 Code of Federal Regulations (CFR):

29 CFR, Part 1910 Hazardous Waste Operation and Emergency Response 40 CFR 61, Subpart M National Emissions Standard for Hazardous Air Pollutants

40 CFR, Part 82 Protection of Stratospheric Ozone

40 CFR, Part 117 Determination of Reportable Quantities for Hazardous Substances

40 CFR, Part 122 National Pollutant Discharge Elimination System (NPDES) Regulations

40 CFR, Parts 260 - 282 Solid Waste Regulations

40 CFR, Part 302 Designation, Reportable Quantities, and Notification

49 CFR, Parts 171-176 Hazardous Materials Regulations, Department of Transportation, (DOT) Rules

1.2 Environmental Protection Agency Publication (EPA):

EPA Publication No. SW-846 Test Methods for Evaluating Solid Waste

1.3 Environmental Laws:

Archaeological and Historic Preservation Act (AHPA)

Archaeological Resources Protection Act (ARPA)

Clean Air Act (CAA) and all amendments

Clean Water Act (CWA) as amended

Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA)

Endangered Species Act (ESA)

Emergency Planning and Community Right-To-Know Act (EPCRA)

Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) as amended

Federal Water Pollution Control Act (FWPCA)

National Oil and Hazardous Substances Contingency Plan (NCP)

Occupational Health and Safety Act (OSHA)

Oil Pollution Act (OPA)

Pollution Prevention Act (PPA)

Resources Conservation and Recovery Act (RCRA)

Safe Drinking Water Act (SDWA), as amended

1.4 State Regulations (Texas Administrative Code):

25 TAC

Occupational Health

30 TAC

General Permit to Discharge Waste

30 TAC

Public Drinking Water

30 TAC

Industrial Solid Waste and Municipal Hazardous Waste

1.5 Air Force Instruction 32-7086

Hazardous Materials Management

2. PROTECTION OF RESOURCES: Construction activities are NOT exempt from air emission, stormwater, hazardous waste, and other environmental compliance rules and regulations. Contractor shall investigate, comprehend, and comply with all environmental rules and regulations applicable to his/her chosen method of accomplishment of the work under this contract.

2.1 Protection of Land Resources: The Contractor shall confine his construction activities to areas defined by the plans and specifications and/or as approved in his/her Storage Area submittal (refer to paragraph 7 of Section 01010). Except in areas to be cleared, the Contractor shall not remove, cut, deface, injure or destroy trees or shrubs without the Contracting Officer's permission. Do not fasten or attach ropes, cables, or guys to existing nearby trees for anchorage unless authorized by the Contracting Officer. Where such use of ropes, cables, or guys is authorized, the Contractor shall be responsible for any resultant damage.

2.2 Protection of the Stratospheric Ozone: The Contractor shall comply with 40 CFR Part 82. To the maximum extent practicable, the Contractor shall utilize safe alternatives and products made with or containing safe alternatives to Class I or II ozone depleting substances, identified under 42 U.S.C. 7671K. Class I Ozone Depleting Substance is defined in section 602 (a) of CAA and includes the following chemicals:

CFC-11

CFC-12

CFC-13

CFC-111

CFC-112

CFC-113

CFC-114

CFC-115

CFC-211

CFC-212

CFC-213

CFC-214

CFC-215

CFC-216

CFC-217

halon-1211 halon-1301 halon-2402 carbon tetrachloride methyl chloroform

Per manufacturer’s recommendations, Contractor shall utilize acceptable refrigerant substitutes such as:

HCFC - 22

HCFC - 123

HCFC - 134A

2.3 Protection of Historical and Archaeological Resources: All known Historical, Archaeological, and Cultural Resources, if any, within the Contractors work area will be designated on the contract drawings. The Contractor shall take precautions during the contract to preserve all resources as they existed at the time of contract award and comply with AHPA and ARPA. The Contractor shall provide all protective devices such as off limit markings, fencing, barricades or other devices as designated on the contract drawings and shall be responsible for preservation of the sites during this contract.

2.3.1 Recording and Preserving Historical and Archaeological Finds: All items having any apparent historical or archaeological interest outside of designated areas which are discovered in the course of any construction activities shall be carefully preserved. The Contractor shall protect the find in-place by leaving the archaeological find undisturbed and by using flags to mark a 50-foot radius area around the find. The find shall be immediately reported to the Contracting Officer so that the proper authorities may be notified. All work shall be stopped in the immediate area of the discovery until directed by the Contracting Officer to resume work. Any work required to preserve or protect these finds shall be accomplished before work resumes.

2.4 Protection of Water Resources: The Contractor shall not pollute streams, lakes, or reservoirs with fuels, oils, bitumens, calcium chloride, acids, construction wastes, siltation from stormwater runoff, or other harmful materials identified in 40 CFR Parts 117 and 302. It is the responsibility of the Contractor to investigate, comprehend, and comply with all applicable federal and state regulations, and county, and municipal ordinances concerning pollution of rivers and streams. All work under this contract shall be performed in such a manner that objectionable or nuisance conditions will not be created in lakes, reservoirs, or streams through or adjacent to the project areas. At least 30 days prior to the start of construction, the Contractor shall apply for coverage under the storm water construction general permit TX 150000, by filing a Notice of Intent (NOI) TCEQ Form 20022 for stormwater discharges associated with his construction activities with the TCEQ for all soil disturbance of more than 1 acre. A pre-requisite of filing the NOI is to prepare a Storm Water Pollution Prevention Plan (SWPPP) meeting all regulatory requirements and show the Contractor’s proposed methodology for controlling erosion, sedimentation, and pollution at the site. Copies of this plan shall be submitted for Government approval (GA) and copies of the NOI shall be submitted for information (FIO). All non-storm water discharges shall be in accordance with the governing state and federal regulations.

2.4.1 For all soil disturbance of more than 1 acre, the Contractor shall prepare a Storm Water Pollution Prevention Plan (SWP3) meeting all requirements specified in the construction general permit and will include the Contractor’s Best Management Practices for erosion and sedimentation control at the site. Copies of this plan shall be submitted for Government approval (GA).

2.4.2 Regardless of the amount of soil disturbed, all non-storm water discharges shall conform with the base’s Storm Water Management Program regulated by TPDES General Permit TXR040000 for Small Municipal Separate Storm Sewer Systems (MS4).

2.4.3 If a Notice of Intent (NOI) is required for permit coverage, the Contractor shall submit the NOI to the state and provide copies to the Government via Form 3000 for FIO. Contractor shall make required MS4 notifications to the City of San Angelo and the base. Copies of all notifications will be provided to the Contracting Officer via Form 3000 FIO. Contractor shall be responsible for fees associated with obtaining coverage under permit TXR150000.

2.4.4 The Contractor shall also file a Notice of Termination (NOT) TCEQ Form 20023 promptly after site stabilization in accordance with the construction general permit is achieved. These forms may be found at the TCEQ website ( http://www.tceq.state.tx.us). The prime Contractor’s principal shall sign to certify the NOI/NOC/NOT or Construction Site Notice. A copy of the NOT shall be provided to the Contracting Officer and Base Environmental Coordinator, FIO.

2.4.5 The Government will specify if the contracted project is part of a larger common development requiring additional storm water measures be taken to obtain permit coverage, or if the project area of construction is greater than 5 acres.

2.4.6 Post-Construction Cleanup or Obliteration: The Contractor shall obliterate all evidence of temporary construction facilities such as haul roads, work areas, structures, foundations of temporary structures, stockpiles of excess materials, or any other vestiges of construction. It is anticipated that excavation, filling, and plowing of roadways shall be required to restore the area to near natural conditions, which will permit the growth of vegetation thereon. The disturbed areas shall be graded and filled as required, and topsoil shall be spread to a depth of approximately four inches over the entire area and the entire area seeded with 30 pounds (pure live seed) of common Bermuda per 1000 square feet and then watered as required until a lush hardy growth is established to the satisfaction of the Contracting Officer. Restoration to original contours is required unless otherwise directed by the Contracting Officer. If applicable, final stabilization shall be achieved prior to terminating the TXR 150000 Construction General Permit coverage.

2.6 Protection of Air Quality: The Contractor shall investigate, comprehend, and comply with all applicable Federal, State, County and Municipal laws concerning air pollution, particularly the CAA (and all subsequent amendments). All work under this contract shall be performed in such a manner that objectionable or nuisance conditions will not be created in the air nor will objectionable particulates be released to the air. Material usage of welding rods, welding gases, paints, thinners, solvents, and asphalt will require reporting to (through Contracting Officer) GAFB Air Program Manager, 17 CES/CEAN (325)-654-5946 monthly throughout the project (VIA AF Form 3000). No open burning shall be permitted on base.

2.6.1 Dust Control: The Contractor shall maintain all excavations, embankments, stockpiles, haul roads, permanent access roads, plant sites, waste areas, borrow areas, and all other work areas within or without the project boundaries free from dust in accordance with all applicable local, state, and Federal regulations for the control of dust and particulate emissions. Temporary methods of stabilization consisting of sprinkling with water are required to control dust. Sprinkling with water shall be repeated at such intervals as to keep all parts of the disturbed area at least damp at all times. Gravel paving shall be provided for entrance and exit drives, parking areas, and unpaved roads carrying more than 25 vehicles per day on the construction site.

3. Disposal Of Wastes (Non-Hazardous, Special, And Hazardous) Generated at Goodfellow AFB: (Refer to Specification Section 01010 paragraph 6.1 for waste determination and classification).

3.1 Non-Hazardous Wastes: Contractor shall transport and dispose of all non-hazardous wastes to and in a State of Texas permitted facility or other disposal facility permitted by the state in which the disposal facility is located.

3.2 Special Wastes: Special wastes are any wastes that are non-hazardous yet have to be stored, transported, and/or disposed of in a special manner, for example, asbestos containing wastes or petroleum contaminated soil. Contractor shall store, transport and dispose of all Special Wastes in accordance with all Federal, State, and local laws, rules and regulations as applicable. Contractor shall dispose of Special Wastes in a State of Texas permitted facility. The disposal facility must also be approved by the Base Environmental Coordinator prior to transportation. Contractor shall make all necessary arrangements with the disposal facility for disposal of Special Wastes. Contractor shall prepare all necessary paper work, including but not limited to bill of lading, manifests, etc. at no additional cost to the Government.

3.3 Hazardous Wastes:

3.3.1 The Contractor shall accumulate, transport and dispose of all hazardous waste in accordance with federal hazardous waste regulations 40 CFR 260-279 and Texas industrial solid and municipal hazardous waste regulation 30 TAC 335, and federal transportation regulations 49 CFR 171-176. The Contractor shall prepare and maintain all records, shipping documents, training certificates, plans and other documents required by regulation. The Contractor shall submit for information (FIO) a copy of all of the records, shipping documents, training certificates, plans and other documents required in Chapter 335 to the Contracting Officer. This includes copies of the manifests and land disposal restrictions. All manifests and land disposal restrictions must be signed by the Base Environmental Coordinator.

3.3.2 The Contractor shall remove all hazardous waste from Goodfellow AFB on a daily basis unless the accumulation and storage is specifically approved in writing by the Contracting Officer and the Base Environmental Coordinator. Such approval must be given prior to the generation of any hazardous waste. Approval for accumulation or storage of hazardous wastes in excess of 55 gallons or greater than 1 quart acutely hazardous waste, for greater than three (3) calendar days will require a minimum lead time of forty-five (45) calendar days from the date of the receipt of the request and may not be approved at that time. The Contractor shall transport hazardous wastes from Goodfellow AFB to a Treatment, Storage, or Disposal (TSD) facility permitted by the State of Texas, the EPA, and approved by the Base Environmental Coordinator. Under no circumstances shall disposal or treatment of hazardous wastes be allowed on Goodfellow AFB by the Contractor.

3.3.3 Aerosol Cans: Aerosol cans, after use, must be punctured and drained of product and propellant via approved equipment manufactured for that purpose. The empty cans may then be recycled as scrap metal. Disposal of the internal can contents shall be accomplished according to its waste classification.

3.3.4 Other Containers: Refer to 30 TAC 335.41(f) for criteria regarding management and disposal of other containers

3.3.5 Contractor shall submit certification of proper disposal (via AF Form 3000) of all wastes including original manifests signed by the transportation agent and the disposal facility operator to the Contracting Officer prior to the Final Inspection.

3.4 The Government will, as is deemed necessary, inspect the Contractor’s operations and records for compliance with state and federal regulations. The Contractor shall cooperate fully with the TCEQ, US EPA and/or Government representatives during these inspections, if any. The Contractor shall be fully and totally responsible for payment of all fines and/or penalties imposed by the TCEQ or US EPA for violation of regulations governing environmental management during performance of this contract.

4. MAINTENANCE OF POLLUTION CONTROL FACILITIES DURING CONSTRUCTION: During the life of this contract the Contractor shall maintain all facilities constructed for pollution control under this contract as long as the operations creating the particular pollutant are being carried out or until the material concerned has become stabilized to the extent that pollution is no longer being created. During the construction period the Contractor shall conduct frequent training courses for his maintenance personnel. The curricula shall include methods of detection of pollution, familiarity with pollution standards, and installation and care of vegetation covers, plants, and other facilities to prevent and correct environmental pollution.

5. PESTICIDES (INSECTICIDES, FUNGICIDES, HERBICIDES, ETC.): Application of all pesticides shall be accomplished by licensed pest control applicators or under the direct supervision of a State of Texas licensed pesticide applicator. Delivery and storage of pesticides shall be monitored by licensed personnel to insure the adequacy of containers and the safe storage of toxic materials. Disposal of containers and chemicals will be monitored to prevent pollution of natural drainage systems or the unintentional release of pesticide particulates into the air. The Contractor shall comply with FIFRA and submit copies of certifications for operator to Contracting Officer (via AF Form 3000) for approval prior to application of pesticides. Additionally, the Civil Engineer Entomology Section at Goodfellow AFB shall be notified at (325)-654-3496 at least five calendar days in advance by the Contractor of proposed application of any pesticides and copies of all application records shall be submitted to the Base Entomology Shop. The Contractor shall use the GAFB pesticide Application Form, available at Base Civil Engineer Asset Management Flight.

6. ENVIRONMENTAL MANAGEMENT SYSTEM (EMS): Contractor’s on site supervisory personnel shall complete EMS Awareness Training in conformance with the base’s EMS. The Base Civil Engineer Asset Management Flight system administrator should be contacted at (325) 654-3451 for information and password to complete the 30-minute awareness training within 30 days of contract award or a new contract employee supervisor begins work. The training will be accomplished utilizing web-based Environmental, Safety, and Occupational Health Training Network (ESOHTN) available through any internet access at http://aetc.esohtn.com/. The training will be tracked online by the system administrator.

7. POLLUTION PREVENTION AND RIGHT TO KNOW REQUIREMENTS:

7.1 Hazardous Materials Requirements and Forms: Contractors using any hazardous materials on Goodfellow AFB must comply with the review and approval process specified in AFI 32-7086, Hazardous Material (HAZMAT) Management. Contractor shall provide the Contracting Officer with a list of proposed hazardous materials that it plans to use on the installation during the performance of the contract using the attached authorization worksheet and MSDS for each hazardous material, Material and Approval Submittal via an AF Form 3000 for Government Approval prior to bringing hazardous materials on, or using the materials on base. The Installation HAZMAT Management Program (IHMP) will determine if any of the proposed materials to be used are HAZMATs.

7.1.1 The Contractor shall report hazardous material usage data to the Civil Engineer Natural Resources Management on a monthly or quarterly basis, as determined by the Contracting Officer and the IHMP via AF Form 3000 for Government Approval. The report will show the product name and part number (stock number if already assigned to each material), any amount received during this period, unit of issue, amount used during this period and any balance left to still be used by the Contractor.

7.1.2 If additional hazardous materials are required during the course of the contract, the Contractor shall complete an authorization worksheet and provide a MSDS for each additional hazardous material prior to the Contracting Officer via AF Form 3000 for Government Approval prior to bringing or using hazardous materials on base. The Contractor shall submit authorization NLT 15 days prior to delivery of hazardous materials to Goodfellow AFB.

7.1.3 For each Contractor-identified chemical that the IHMP determines does not meet the Air Force definition of a HAZMAT, IHMP requirements do not apply. IHMP will notify the Contracting Officer that the Contractor has authorization to bring and use that material on the installation without reporting usage use unless required under Green Procurement Program or specifications requiring data submittals.

7.1.4 For each Contractor-identified material that the IHMP determines does meet the Air Force definition of a HAZMAT, Civil Engineer (CE) authorization of the AF Form 3952 Hazardous Materials Authorization/Review Request Form with required supporting documentation, to include a current Material Safety Data Sheet (MSDS) is required. The IHMP authorization must be obtained prior to bringing, or using HAZMAT on Goodfellow AFB.

7.1.5 If the hazardous material request is for a Class I ODS, CE will ensure there is an applicable and current Air Force Senior Acquisition Official (SAO) approval for contract Class I ODS requirements before approving the hazardous material authorization and make available to the Contractor. The Contracting Officer will also maintain a copy of the SAO approval in the contract file as required by AFI 32-7086.

7.1.6 If there is a change in IHMP-approved HAZMAT, the Contractor shall promptly notify the Contracting Officer and resubmit data as required.

7.2 Reporting Requirements: The Contractor shall submit all information needed by the base to comply with the following:

a. Emergency planning reporting requirements of Section 302 of EPCRA.

b. Emergency notice requirements of Section 304 of EPCRA

c. List of Material Safety Data Sheets required by Section 311 of EPCRA d.

Emergency and hazardous chemical inventory forms of Section 312 of EPCRA e.

Toxic chemical release inventory of Section 313 of EPCRA, which includes the reduction and recycling information required by Section 6607 of PPA

d. Toxic chemical reduction goals requirements of Section 3-302 of Executive Order 12856

e. Pollution Prevention and Right-to-Know Information as per the FAR 52.223-5 (Apr 1998)

f. Executive Order 13148 Greening the Government Through Leadership in Environmental Management

g. Executive Order 13423, Strengthening Federal Environmental, Energy and Transportation Management

8. SPILLS: Goodfellow AFB maintains, follows, and enforces the following spill plans for regulated substances

a. Hazardous Materials Emergency Response Plan

b. Spill Prevention Control and Counter Measures Plan

c. National Oil and Hazardous Substance Pollution Contingency Plan

These plans are maintained by the Asset Management Flight of Civil Engineering at 460 E. Kearney Blvd, Goodfellow AFB. The Contractor shall take preventive measures (secondary containment for fuel storage, avoid overfilling of trucks, etc.) to avoid spills. If a spill does occur, the Contractor shall immediately notify the Base Fire Department at phone number 654-3534. The Base Fire Department is the first responder who will take charge to secure/neutralize the event, if required and will coordinate cleanup/remedial actions. Notification shall be made even if the spill is within the cleanup capabilities of the Contractor.

Accordingly, the Contractor shall report all spills immediately, as they occur, to permit proper response by Goodfellow AFB and Contractor personnel. Contractor may be held liable for all expenses incurred by the Government during the spill response and any cleanup operations including but not necessary limited to a hazardous materials/wastes cleanup, Contractor supplies and equipment rental, waste transportation, laboratory analysis, and disposal costs.

9. DEMOLITION

9.1 Demolition Notification: When a project involves demolition, a written notification on the form specified by the Texas Dept. of State Health Services (DSHS), shall be received by the DSHS at least twenty (20) calendar days prior to Contractor’s proposed demolition start date. The notification shall be signed by Base Asset Management Coordinator. Contractor shall be responsible for this notification and bring it to 17 CES/CEA for signature prior to mailing to the DSHS. Contractor shall submit a copy of the signed notification to the Contracting Officer annotated with the date of mailing to the DSHS. The Government will be responsible for timely payment of all fees associated with the work.

9.2 The Contractor shall use all means available to divert to the greatest extent practicable and economically feasible, construction and demolition waste from landfills. At the end of the project, and prior to final acceptance, the Contractor shall submit a solid waste diversion report by completing the form at the end of this section identifying the materials and weights either recycled or diverted from solid waste disposal to other re-use as well as weights of waste disposed in a landfill. The report shall be submitted via AF Form 3000 to the Contracting Officer for Government Approval.

10. ASBESTOS:

10.1 Abatement: When a project involves asbestos abatement, a written notification on the form specified by the Texas Dept. of State Health Services (DSHS), shall be received by the DSHS at least twenty (20) calendar days prior to Contractor’s proposed asbestos abatement start date. The notification shall be signed by Base Environmental Coordinator. Contractor shall be responsible for this notification and bring it to 17 CES/CEA for signature prior to mailing to the DSHS. Contractor shall submit a copy of the signed notification to the Contracting Officer annotated with the date of mailing to the DSHS. The Government will be responsible for timely payment of all fees associated with the work.

10.2 Asbestos Containing Building Materials: Under no circumstances, under the provisions of this contract, shall the Contractor be allowed to provide asbestos containing building materials, or products containing encapsulated asbestos or mineral fibers as defined in the 40 CFR 61, National Emission Standards for Hazardous Air Pollutants of 1990, to GAFB.

11. LEAD

Under no circumstances, under the provisions of this contract, shall the Contractor be allowed to provide Lead Based paint, paint products or lead building materials. The definition of Lead Based Paint is paint or other surface coating that contains lead to or in excess of 1.0 milligrams per square centimeter or more than .5% by weight (5000ppm). Consumer Products Safety Commission redefined the definition as per the ban on lead based paint as a surface coating in excess of .06 % IAW section 302 (c) of the Lead Based Paint Poisoning Prevention Act, 16 CFR 1303.

12. RELEASE OF FLUIDS TO THE SANITARY SEWER SYSTEM:

Goodfellow AFB’s sanitary sewer system discharges into the Publicly Owned Treatment Works (POTW) operated by the City of San Angelo, Texas. This POTW has established testing requirements for certain constituents as well as discharge limits of those same constituents. Accordingly, any Contractor performing work at Goodfellow AFB and contemplating a release of non-hazardous water into the sanitary sewer system shall comply with the testing/release requirements established by the City of San Angelo. Contractor is also responsible for any and all testing, monitoring, measuring, documenting, etc. to prove compliance with same.

INSTRUCTIONS FOR USE OF THE AF-EMIS AUTHORIZATION REQUEST WORKS

1. Tab through each block, some blocks will have instructions that will appear at the bottom of your screen; other blocks are either self explanatory or have a drop down box with authorized inputs.

2. Complete all required blocks in Sections I and II for Government Approval.

3. Enter specific manufacturer’s material.

4. Sections III – requiring Documents – enter appropriate data when applicable.

5. Section IV – Process Information. Complete all blocks in this section For Information Only

a. Block 19a, if you answer YES to this question, you must complete blocks 19b and 19c.

b. Block 22, Enter the appropriate amount and the information from table 1 below.

c. Block 27, If PPE is required, Check all appropriate boxes in Table 2, and submit Table 2 with the worksheet.

d. Block 28a thru 28c only requires entries when respirators are required.

e. Block 33, if you answer YES to this question, you must complete Block 33a.

6. Section V – Remarks is self-explanatory.

7. Section VI – All entries must be completed in both Blocks 41 and 42, to include signatures.

8. You must submit a Material Safety Data Sheet, (MSDS) with this form.

9. Should you have any questions on completing this form, please contact HAZMO at 654-3299.

PRINTING THE FORM:

PRINT PAGES 2 AND 3 IN DUPLEX MODE SO THAT THE FRONT

AND BACK OF THE FORM ARE ON ONE PIECE OF PAPER

FORMDROPDOWN

END DATE:

(Req. for Limited & One-time uses)

2. PROCESS CODE/TASK CODE(S)

SECTION I REQUESTOR INFORMATION

3. COMMAND/ORGANIZATION/OFFICE SYMBOL

4. WORKCENTER TITLE:

FORMDROPDOWN

SECTION II MATERIAL INFORMATION

5. SUPPLY ACCOUNT CODES:

6. Building #

7. Location:

8. Material Name:

9. NSN/LSN:

10. Unit of Issue:

11. Container Type and Size:

FORMDROPDOWN

FORMDROPDOWN

12. Material Specification:

13. Draw Amount:

14. Draw Frequency:

15. Sole Source Manufacturer Name/CAGE:

16. Sole Source Part #/ Trade Name:

SECTION III REQUIRING DOCUMENTS

SECTION IV PROCESS INFORMATION

(All question in this section must be completed)

17. Is this request for a new workload or process in the shop? FORMDROPDOWN

18. Is this a new material for the shop? FORMDROPDOWN

19a. Will this authorization replace another authorization? FORMDROPDOWN , if YES, complete 19b and 19c 19b. Enter the Control ID of authorization being replaced:

19c. Replace Reason:

FORMDROPDOWN

20. Application Method: (Alphabetical)

A-R: FORMDROPDOWN

S-V: FORMDROPDOWN

21. Task (Fully describe work activity and process in which material is used)

22. Amount of material used per task: (See Table 1 above)

23. Frequency of Task:

time(s) FORMDROPDOWN

26. Will engineering controls used during the process (such as exhaust/ventilation systems, etc.) FORMDROPDOWN , If Yes select appropriate item(s) below:

FORMCHECKBOX

- CANOPY HOOD, FORMCHECKBOX

- COOLING COIL, FORMCHECKBOX

- COVERED TANK, FORMCHECKBOX

- ENCLOSURES, FORMCHECKBOX

- EXHAUST VENTILATION SYSTEM, FORMCHECKBOX

- FANS,

FORMCHECKBOX

- GENERAL VENTILATION, FORMCHECKBOX

- OPEN AIR/OUTDOOR, FORMCHECKBOX

- OPEN WINDOWS/DOORS, FORMCHECKBOX

- PAINT BOOTH, FORMCHECKBOX

- WELL VENTILATED AREA

27. Will Personal Protective Equipment (PPE) be used in conjunction with this activity: FORMDROPDOWN , (If yes, See table 2 below, and submit table 2 with this request)

28. If a respirator is required, please select appropriate type:

28b. Manufacturer:

28c. Model #:

29. Is the process performed in a facility, aircraft, equipment, manhole, or other structure? FORMDROPDOWN

30. Is the process performed outdoors? FORMDROPDOWN

31. Is the process performed in a small or restricted space? FORMDROPDOWN

32. Is the process performed in a confined space? FORMDROPDOWN

33. Will process be performed in a location other than the shop? FORMDROPDOWN

34. Where will unused material be stored?

33a. If answer to 33 is YES, enter location(s) here:

35. Will material be heated during process? FORMDROPDOWN , if YES

Method: FORMDROPDOWN

Temp Range: Min , Max , Degree FORMDROPDOWN

36. Will the material be pressurized during process? FORMDROPDOWN , If Yes

Method: FORMDROPDOWN

Working Pressure Range: Min , Max at FORMDROPDOWN

37. Will industrial equipment be used? FORMDROPDOWN

If yes, what type? FORMDROPDOWN

38. Will material be mixed? FORMDROPDOWN

If yes, what method? FORMDROPDOWN

39. Is waste generated during this process: FORMDROPDOWN , if yes, select appropriate item: FORMDROPDOWN , provide additional info below, i.e. disposition of waste.

SECTION V REMARKS

40. Provide additional information:

SECTION VI CERTIFICATION

41. Requester’s Name: , Title: , ORG/Office Symbol: , Duty Phone: , Date:

Signature: __________________________________

42. Certifying Official’s Name: , Title: , ORG/Office Symbol: , Duty Phone: , Date:

Signature: __________________________________

TABLE 1, Amount Used Per Task

(Enter one of the following in Block 22 below)

AF-EMIS Control ID: ________________________________

TABLE 2 – PERSONAL PROTECTIVE EQUIPMENT (PPE)

(Check all that apply)

FORMCHECKBOX

- BARRIER CREAM

FORMCHECKBOX

- BODY – Face Shield, Eye Goggles, Gloves

FORMCHECKBOX

- FALL PROTECTION

FORMCHECKBOX

- FEET - RUBBER BOOTS

FORMCHECKBOX

- HEAD – HELMET

- BODY & LEG: (Check at least one from column A and B)

FORMCHECKBOX

- Apron

FORMCHECKBOX

- CWD Gear

FORMCHECKBOX

- Coat

FORMCHECKBOX

- Coveralls

FORMCHECKBOX

- Firefighting gear

FORMCHECKBOX

- Jacket

FORMCHECKBOX

- Leggings

FORMCHECKBOX

- Old Clothing

FORMCHECKBOX

- Overalls

FORMCHECKBOX

- Pants

FORMCHECKBOX

- Tyvek Suit

FORMCHECKBOX

- Asbestos/Kevlar/Zetex

FORMCHECKBOX

- Butyl Rubber

FORMCHECKBOX

- Chlorinated Polyethylene

FORMCHECKBOX

- Chrome Leather

FORMCHECKBOX

- Coated Fabric

FORMCHECKBOX

- Fabric

FORMCHECKBOX

- Leather

FORMCHECKBOX

- Metal Mesh

FORMCHECKBOX

- Natural Rubber

FORMCHECKBOX

- Neoprene

FORMCHECKBOX

- Nitrile Rubber

FORMCHECKBOX

- Nitrile-Butadiene Rubber

FORMCHECKBOX

- Nitrile/Polyvinyl Chloride

FORMCHECKBOX

- Polyethylene

FORMCHECKBOX

- Polyurethane

FORMCHECKBOX

- Polyvinyl Alcohol

FORMCHECKBOX

- Polyvinyl Chloride

FORMCHECKBOX

- Styrene-Butadiene Rubber

FORMCHECKBOX

- Vinyl

- Vitol

- EYE & FACE:

- Face Shield

- Face Shield, Welding

- Goggles

- Goggles, Dust

FORMCHECKBOX

- Goggles, Laser

- Goggles, Welding

- Helmet, Welding

FORMCHECKBOX

- Safety Glasses

FORMCHECKBOX

- Safety Glasses w/ side shields

- FACE:

- Dust Particulate Mask

FORMCHECKBOX

- Eye Goggles, Face shield

- Goggles

- Goggles, Safety

FORMCHECKBOX

- Respirator, MSHA/NIOSH Approved (See block 28 of worksheet)

- FOOT: Footwear

- Arctic

- Conductive

- Electrical Safety

- Foundry

- Metatarsal Guard

- Protective

- Puncture Resistant

- Safety Toe

- Spark Resistant

FORMCHECKBOX

- HANDS:

FORMCHECKBOX

- Gloves

FORMCHECKBOX

- Latex

FORMCHECKBOX

- Latex Gloves

FORMCHECKBOX

- HAND & ARM - Gloves

MATERIAL

FORMCHECKBOX

- Anti-Vibration

FORMCHECKBOX

- Asbestos/Kevlar/Zetex

FORMCHECKBOX

- Butyl Rubber

FORMCHECKBOX

- Chlorinated Polyethylene

FORMCHECKBOX

- Chrome Leather

FORMCHECKBOX

- Coated Fabric

FORMCHECKBOX

- Fabric

FORMCHECKBOX

- Gauntlet Acid Resistant

FORMCHECKBOX

- Leather

FORMCHECKBOX

- Metal Mesh

FORMCHECKBOX

- Natural Rubber

FORMCHECKBOX

- Neoprene

FORMCHECKBOX

- Nitrile Rubber

FORMCHECKBOX

- Nitrile-Butadiene Rubber

FORMCHECKBOX

- Nitrile/Polyvinyl Chloride

FORMCHECKBOX

- Polyethylene

FORMCHECKBOX

- Polyurethane

FORMCHECKBOX

- Polyvinyl Alcohol

FORMCHECKBOX

- Polyvinyl Chloride

FORMCHECKBOX

- Styrene-Butadiene Rubber

FORMCHECKBOX

- Vinyl

- Vitol

- HEARING - FORMDROPDOWN

- UNKNOWN/OTHER:

- Belt, Lifting

FORMCHECKBOX

- Eye Wash Station

FORMCHECKBOX

- Safety Shower

FORMCHECKBOX

- Long Sleeve Shirt

FORMCHECKBOX

- Wrist Rest

Construction Waste Management Form

Contractor: _________________________________

Asphalt

Bricks

Concrete

Dirt/Soil

Dumpster Debris

Freons/Refrigerants

Light Bulbs

Lumber/Wood

Metals

Oil/Petroleum

Plastics

Roofing

Steel

Wastewater

San Angelo Area Recycling Haulers and Markets

Ric Abbott Co., 6577 S. US Hwy 277, San Angelo (325)-656-4087

Acme Iron & Metal Co., 720 N. Buchanan, San Angelo (325)-653-1407

Butts Recycling Inc., 615 W 11th St, San Angelo (325)-653-8957

SAFE Citizen’s Recycling Center, 702 Warehouse Rd., San Angelo (325)-659-0722

San Angelo Area Landfill

Trashaway Services Inc., 3002 Old Ballinger Hwy, San Angelo (325)-655-6869

END OF SECTION

Section 01400 – Page 15 of 15