Attach 1 EMIS Contractor Instruction Guide.pdf

Solicitation No: FA4460-11-R-0008

Attachment 1

LITTLE ROCK AFB AF-EMIS CONTRACTOR INSTRUCTION GUIDE

This information is required in order to help the base Hazardous Material Office (HAZMO) track all hazardous materials on-base. A worksheet must be filled out for each product containing a hazardous material. All blocks must be filled in.

1. Contractor Name: Fill in the name of the contracting company performing the work. Contract Number: Fill in contract number or project number

Estimated Start Date: Fill in the date the project is projected to start.

Estimated Completion Date: Fill in the date the project is projected to end.

Shop Information: Fill in the AF-EMIS shop code that will be used to track the hazardous materials in the Air Force

Environmental Management Information System. If you do not know this code, leave it blank. You will be assigned a shop code if you do not already have one.

2. Material Information: Information about the hazardous material that is going to be used.

National Stock Number, Local Stock Number, or Part Number: Fill in the identifying number of the product to be used.

Material Noun: Fill in the general term used to define the product. Example: Adhesive, Ni-cad Battery, etc.

Size: Fill in the quantity, circle the unit of measure, and circle the container type.

Unit of Issue: Fill in how the product is received. Example: box, case, pallet, each, etc.

Units Per Container: Identify how much comes in each unit of issue. Example: Twelve cans per box. Twelve being units per container and box being the unit of issue.

3. Location Information: Information about what the product will be used on, where it will be used, and where it will be stored when not in use.

Check all boxes that apply pertaining to where and on what the process of using the hazardous material will occur.

Location of Process: Identify in the physical location of where the product will be used. Example: Building number, intersection street names, etc.

Location of Stored Materials: Identify the physical location of where the material will be stored when not in use.

4. Additional Information: Information for the purpose of completing reports.

Hazardous Waste Generated: Does the process create any hazardous waste?

Site Diagram Available: Is a site diagram available for additional information on the site where the product will be used and stored?

Little Rock AFB SPCC Red Plan: This is part of the base Spill Prevention, Control, and Countermeasures Plan. The Red

Plan lists base procedures for reporting spills.

5. Certifier Block: The certifier is the Government Representative for the project. This block must be completed and signed by both parties.

Notes:

A Manufacturer Material Safety Data Sheet (MSDS) for use by the Hazardous Materials Office is required to be turned in each time a worksheet is completed.

Each month a Contractor Hazardous Material Usage Data Sheet must be completed by the contractor and turned into the

Government Representative for any project over six months. Projects less than six months are required to turn in a data sheet after completion of project. The Government Representative will be responsible for turning over this information to the HAZMO.

LITTLE ROCK AFB AF-EMIS CONTRACTOR WORKSHEET

(Fill In All Information)

NOTE: Manufacturer’s Material Safety Data Sheet (MSDS) Required With Every Worksheet

1. CONTRACTOR INFORMATION

Contractor Name

Contract Number

Estimated Start Date

Estimated Completion Date

AF-EMIS Shop Code (Leave shop code blank if not known)

2. MATERIAL INFORMATION

National Stock Number (NSN), Local Stock Number (LSN), Or Part Number

Material Noun (Be Specific)

Size (Quantity) CIRCLE ONE Fluid Oz Troy Oz

Container Type Box Bottle Can Drum Bag Gram Pint Pound

Cartridge Other____________ Quart Kg Gallon

Unit of Issue Units Per Container Other _______________

3. LOCATION INFORMATION

Will The Process Be Performed On: (Check All That Apply)

Existing Facility Equipment New Structure Aircraft Outdoors

Physical Location Of Process

Location Of Stored Materials

4. ADDITIONAL INFORMATION (Circle Answer That Applies)

Is A Hazardous Waste Generated? Yes No Additional Remarks:

Is A Site Diagram Available? Yes No

Is The SPCC Red Plan Posted? Yes No

5. CERTIFIER BLOCK

This Request Cannot Be Processed Without A Government Representative’s Signature

Contractor Title: Phone: Date

Printed Name

Signature

Gov’t Rep Title: Phone: Date

Printed Name Signature

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.

Material Name Manufacturer NSN/LSN or Part #

Quantity in Stock

Quantity Used

Printed name and Signature:

Contractor: __________________________________________________________________Date__________

Government Rep: _____________________________________________________________Date__________