007200_Attch7b_Monthly Hazardous Usage Report.pdf
PDF 123 KB Posted
- Solicitation number
- FA813725R0035
About this file
The document is a Monthly Hazardous Material Usage Report template designed for contractors to track and report chemical usage on a military installation. The form requires detailed documentation including contract number, contractor information, product details, and quantitative measurements of hazardous material brought on-site, used, stored, and removed. The form captures critical information such as product nomenclature, trade name, part number, manufacturer details, physical storage locations, and the specific description of how the product is used. The form provides multiple unit of measure options including gallons, units, pints, fluid ounces, and pounds, allowing flexible reporting of chemical quantities. The template is associated with the Tinker Air Force Base MAC BOA solicitation (FA813725R0035) for a fire suppression system repair project, and is intended to help maintain safety and tracking protocols for hazardous materials used during contract performance.
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Text version
MONTHLY HAZARDOUS MATERIAL USAGE REPORT
REPORT ON CHEMICAL USAGE
1. GENERAL INFORMATION
Contract Number _________________ Contract Performance Period ______________
Contractor's Name ___________________________ Date of Report _______________
Name of On-Base Contractor Point of Contact ________________________________
Phone Number of Contractor On-Base Point of Contact ________________________
Emergency Phone Number _____________________________________________________
Address or Physical Location of the Contractor's Field Office
2. PRODUCT INFORMATION
Product Nomenclature _______________________________________________________
Product Trade Name _________________________________________________________
Product Part Number ________________________________________________________
Manufacturer's Name ________________________________________________________
Manufacturer's Address _____________________________________________________
Physical Locations(s) of On-Base Usage and Storage
_____ Same as Above _____ Other
Description of How Product is used _________________________________________
3. USAGE/STORAGE AMOUNT
Unit of Measure: ______ Gallon(s) ______ Unit(s) ______ Pint(s)
______ Fluid Ounce(s) ______ Pound(s)
______ Other (Specify) _______________________________
Amount Brought Amount Used During Amount Amount on Installation Reporting Period Stored Removed
Signature __________________________________________________________________
(Responsible Contractor)
(Continue on additional sheets if needed)
| Contract Number: |
| Contract Performance Period: |
| Contractors Name: |
| Date of Report: |
| Name of OnBase Contractor Point of Contact: |
| Phone Number of Contractor OnBase Point of Contact: |
| Emergency Phone Number: |
| Address or Physical Location of the Contractors Field Office: |
| Product Nomenclature: |
| Product Trade Name: |
| Product Part Number: |
| Manufacturers Name: |
| Manufacturers Address: |
| Physical Locationss of OnBase Usage and Storage: |
| Same as Above: |
| Other: |
| Description of How Product is used: |
| undefined: |
| Units: |
| Unit of Measure 1: |
| Unit of Measure 2: |
| Unit of Measure 3: |
| Fluid Ounces: |
| Other Specify: |
| on Installation: |
| Reporting Period: |
| Stored: |
| Removed: |
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