Attachment4-CESHAZMATReport.doc

SOLICITATION NO.: FA4460-06-R-0007

CONTRACT NO.: FA4460-06-D-______

CONTRACTOR HAZARDOUS MATERIAL USAGE DATA

Contractor:

AF-EMIS Shop Code: __________________

Contract Number:

Locations______________________________________

The following information is required for tracking of hazardous materials on-base. For contract times exceeding six months, this form is required to be filled out monthly and returned to the Government Representative, who will return it to the HAZMO office. This information is required in order to comply with Environmental Laws and Regulations. For purchase orders/contracts less than six months, this form is required at start and upon completion of work.

or Part # Quantity in Stock Quantity

Used

Printed name and Signature:

Contractor: __________________________________________________________________Date__________

Government Rep: _____________________________________________________________Date__________ Attachment 3