Appendix_F--Hazardous_Materials_Forms.pdf

PDF 3 MB Posted Oct 4, 2019

Attached to: Hoist and Crane Maintenance Services Federal contract opportunity
Solicitation number: FA485520QAXXX1
Issued by: Department of the Air Force Special Operations Command

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Appendix F - Hazardous Materials Form

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File	Type	Posted
Appendix_C--Work_Request_Form.pdf	PDF	Oct 4, 2019
DRAFT_27_SOW_Hoist_+_Crane_Maint_Svc_PWS_17_Sep_19.pdf	PDF	Oct 4, 2019
Appendix_E--CAFB-MAFR_Contractor_Guide_2018.pdf	PDF	Oct 4, 2019
Appendix_A--29_May_19.pdf	PDF	Oct 4, 2019
Appendix_D--Deliverables.pdf	PDF	Oct 4, 2019
Appendix_B--Publications.pdf	PDF	Oct 4, 2019

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ATTACHMENT 1

CAFB & MAFR Contractor

HAZMAT Worksheet

1. Contractor Information

Contractor Name:

Contract Number:

Project Number:

Estimated Start Date:

Estimated Completion Date:

Assigned Shop Code, if known:

2. Material Information

Material Name (from SDS):

Material Stock No. (MSN), or National Stock No.

(NSN), or Local Stock No. (LSN), enter if known:

Container Type (check one):

Box

Bag Tube

Bottle Can

Drum

Container Volume or Weight (check one):

Weight Oz. GramsPounds Tons

Quarts

Gallons

Other(Specify):

Total No. of Containers: Container Size: Total HAZMAT

Quantity:

3. Process Information

Process Type:

Process Description:

4. Engine ering

Describe process engineering controls:

5. Personal Protective Equipment (PPE)

Describe process PPE:

6. Location Information

Process will be performed on/at (check all that apply):

Existing Facility Aircraft Outdoors

E quipment New Facility

Other (Specify):

Physical location of process:

Staging location of HAZMAT:

Other (Specify)

Kilograms Fluid Oz Pints

Cartridge

ATTACHMENT A-1

Cannon AFB & Melrose AFR

Contractor HAZMAT

IAW FAR 52.223-3/AFI 32-7086 3.4.1; All HAZMAT brought onto an installation for use shall be authorized via the process described in this section.

NOTE: Manufacturer’s Safety Data Sheet (SDS) is required for every worksheet

The information submitted is complete. The HAZMAT noted above may enter Cannon AFB and/or Melrose AFR

The information submitted is incomplete and/or erroneous. Please follow the instruction below and resubmit.

7. Additional Information

Will a hazardous waste be generated (circle one)?

Yes No TBD Describe method(s) of waste management, transport, and disposal:

8. Contractor Signature Block

Title Phone Number

Printed Name Date

Signature

9. Environmental Approval Signature Block

Title Phone Number

Printed Name Date

Signature

ATTACHMENT 2

CAFB & MAFR Contractor HAZMAT Usage

Worksheet

1. Project Information

Contractor Name:

Contract Number: Project Number:

Project Location: Shop Code (if known):

Project Start Date: This worksheet is required monthly on the 5th for project is >60 days, and projects <60 Days, once at the projects end.

Project Est. End Date:

2. Reporting Information

Reporting Date:

Name:

3. Material Usage

HAZMAT Name (SDS) MSN Container Size

(w/ Unit of Measure) Containers Used

This Period

Estimated Start Date:

Estimated Completion Date:

Assigned Shop Code if known:

Material Name from SDS:

Material Stock No MSN or National Stock No NSN or Local Stock No LSN enter if known:

Weight Oz Pounds Tons Grams Kilograms Fluid Oz Pints Quarts Gallons Other SpecifyTotal No of Containers:

Container Size:

Total HAZMAT Quantity:

Process Type:

Process Description:

Describe process engineering controls:

Describe process PPE:

Other Specify:

Describe methods of waste management transport and disposal:

Title:

Phone Number:

Printed Name:

Date:

Title_2:

Phone Number_2:

Printed Name_2:

Date_2:

Specify:

Location:

Staging location of HAZMAT:

Group11: Off

Group12: Off

Group13: Off

Clear Form:

Group4: Off

Check Box1: Off

Dropdown9: [N/A]

Text10:

Check Box11: Off

Contractor Name:

Contract Number:

Project Number:

Project Location:

Shop Code:

Project Start Date:

Project Est End Date:

Reporting Date:

Name:

HAZMAT Name SDSRow1:

MSNRow1:

Container Size w Unit of MeasureRow1:

Containers Used This PeriodRow1:

HAZMAT Name SDSRow2:

MSNRow2:

Container Size w Unit of MeasureRow2:

Containers Used This PeriodRow2:

HAZMAT Name SDSRow3:

MSNRow3:

Container Size w Unit of MeasureRow3:

Containers Used This PeriodRow3:

HAZMAT Name SDSRow4:

MSNRow4:

Container Size w Unit of MeasureRow4:

Containers Used This PeriodRow4:

HAZMAT Name SDSRow5:

MSNRow5:

Container Size w Unit of MeasureRow5:

Containers Used This PeriodRow5:

HAZMAT Name SDSRow6:

MSNRow6:

Container Size w Unit of MeasureRow6:

Containers Used This PeriodRow6:

HAZMAT Name SDSRow7:

MSNRow7:

Container Size w Unit of MeasureRow7:

Containers Used This PeriodRow7:

HAZMAT Name SDSRow8:

MSNRow8:

Container Size w Unit of MeasureRow8:

Containers Used This PeriodRow8:

HAZMAT Name SDSRow9:

MSNRow9:

Container Size w Unit of MeasureRow9:

Containers Used This PeriodRow9:

HAZMAT Name SDSRow10:

MSNRow10:

Container Size w Unit of MeasureRow10:

Containers Used This PeriodRow10:

HAZMAT Name SDSRow11:

MSNRow11:

Container Size w Unit of MeasureRow11:

Containers Used This PeriodRow11:

HAZMAT Name SDSRow12:

MSNRow12:

Container Size w Unit of MeasureRow12:

Containers Used This PeriodRow12:

HAZMAT Name SDSRow13:

MSNRow13:

Container Size w Unit of MeasureRow13:

Containers Used This PeriodRow13:

HAZMAT Name SDSRow14:

MSNRow14:

Container Size w Unit of MeasureRow14:

Containers Used This PeriodRow14:

HAZMAT Name SDSRow15:

MSNRow15:

Container Size w Unit of MeasureRow15:

Containers Used This PeriodRow15:

HAZMAT Name SDSRow16:

MSNRow16:

Container Size w Unit of MeasureRow16:

Containers Used This PeriodRow16:

HAZMAT Name SDSRow17:

MSNRow17:

Container Size w Unit of MeasureRow17:

Containers Used This PeriodRow17:

HAZMAT Name SDSRow18:

MSNRow18:

Container Size w Unit of MeasureRow18:

Containers Used This PeriodRow18:

HAZMAT Name SDSRow19:

MSNRow19:

Container Size w Unit of MeasureRow19:

Containers Used This PeriodRow19:

HAZMAT Name SDSRow20:

MSNRow20:

Container Size w Unit of MeasureRow20:

Containers Used This PeriodRow20:

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