JA11- 01 57 19 Appendix C_EAFB Waste Determination Form.pdf

PDF 1 MB Posted

Attached to
Maintain Boiler 4 Federal contract opportunity
Solicitation number
FA500422B0006
Issued by
Department of the Air Force Pacific Air Forces

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This document contains a hazardous waste determination form and details of a federal contract opportunity for maintaining Boiler 4 at Eielson Air Force Base in Alaska. The hazardous waste determination form provides a template for requestors to document the characteristics, constituents, and hazardous properties of generated wastes to determine regulatory status.

The federal contract opportunity is an invitation for bid for repair and maintenance services for Boiler 4 at the Central Heat and Power Plant on Eielson Air Force Base. The estimated value is between $5-10 million. The solicitation is a total small business set-aside for North American Industry Classification System code 236220 with a small business size standard of $39.5 million. Bids are due by May 12, 2022. A mandatory site visit will be held on April 21, 2022, with questions due by April 25, 2022. The work must be completed within 154 calendar days of award. The selected contractor will be required to provide payment and performance bonds.

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HAZARDOUS WASTE DETERMINATION FORM

Hazardous Waste Determination Form #:

A. WASTE DESCRIPTION:

Generation Process:

Generation location and/or system: Total Quantity and/or Estimated Generation rate:

B. WASTE PROPERTIES, CHARACTERISTICS, and CONSTITUENTS:

pH: [ ] < 2 [ ] > 2 but < 12.5

[ ] N/A [ ] > 12.5

Physical [ ] Solid State: [ ] Solid w/freestanding or absorbed liquid

[ ] Liquid (If liquid, indicate if the liquid is:

[ ] Single Layer [ ] Multi-layer

[ ] Gas

Flashpoint: [ ] < 140 oF [ ] > 140 oF but < 200 oF

[ ] N/A [ ] > 200 oF Characteristics: Asbestos

Content:

PCB Content: Metal Content:

[ ] Antimony* [ ] Arsenic [ ] Barium [ ] Beryllium* [ ] Cadmium

[ ] Chromium [ ] Cobalt* [ ] Copper* [ ] Lead [ ] Mercury

[ ] Molybdenum* [ ] Nickel* [ ] Selenium [ ] Silver [ ] Thallium*

[ ] Vanadium* [ ] Zinc*

[ ] None

[ ] Corrosive [ ] Ignitable [ ] Reactive [ ] Radioactive [ ] Toxic

[ ] Friable [ ] Non-Friable

[ ] None

[ ] > 5 ppm [ ] < 5 ppm

[ ] None

*Check these metals (or metal compounds) only if they are in a friable, powdered, or finely divided state.

Composition (list all constituents, including debris, any absorbent, freestanding liquid, or absorbed liquid):

Constituent: Volume % (range): Constituent: Volume % (range):

C. REMARKS (Attach all applicable documentation describing the waste (e.g. process knowledge statement, MSDS, manufacturer's specifications, sample analysis, etc.):

D. REQUESTOR’S CERTIFICATION [By signing the form, the requestor certifies (based on process knowledge or certified records) that all information is complete and accurate to the best of his/her knowledge.]

REQUESTOR NAME/SIGNATURE: DEPARTMENT/GROUP: EXTENSION: DATE:

Upon completing Blocks A, B, C, and D above, the requestor will forward the form to the Contracting Officer who will in turn route the form to the Eielson Project Manager for processing through the Installation Environmental Office. The Installation Hazardous Waste Program Manager will complete Page 2 of the form and the form will be routed back to the PM and Contracting Officer. The Contracting Officer will provide the completed form back to the Contractor.

01 57 19 - APPENDIX

HAZARDOUS WASTE DETERMINATION FORM

For Installation Environmental Office Use Only

Hazardous Waste Determination Form #:

For Installation Hazardous Waste Program Manager Use Only

[ ] Sample Analysis Required (specify):

EPA Waste Codes: Hazardous Classification:

[ ] Non-Hazardous

[ ] RCRA Waste

[ ] Non-RCRA Waste (CA Haz Waste)

[ ] TSCA Waste

Remarks:

Installation Hazardous Waste Program Manager NAME/SIGNATURE: DATE:

01 57 19 - APPENDIX

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