JH.1-1_11_ATTACHMENTS.pdf

CONTRACTOR HAZARDOUS MATERIAL INVENTORY REQUEST (CHMI) Ref: PSNS&IMFINST P4110.1 HM Serial No.

Check appropriate box1: Initial Request Monthly Report Mo/Yr Final Report Page PRIME CONTRACTOR/COMPANY NAME SUBCONTRACTOR (If Applicable) CONTRACT NUMBER ESTIMATED COMPLETION DATE

* CONTRACTOR REPRESENTATIVE (POC) PRIME SUB PROJECT NAME2 WORK SITE LOCATION3

Certification Signature/Date Printed Name

CONTRACTOR PHONE (POC) CONTRACTOR FAX (POC)

C O N T R A C T O R

CONTRACTING OFFICE CONTRACTING OFFICE REP (COR) COR PHONE COR FAX SUBMITTAL DATE C O R

CODE 106.34 REVIEWER’S NAME & INITIALS CODE 106.34 PHONE CODE 106.34 FAX RECEIPT DATE REVIEW DATE H M

CONTRACTOR HM TECH REVIEW CONTRACTOR

Monthly Reporting Quantities 8

Number or fraction of containers Trade Name 4

♦Name on product & MSDS must match ♦For kits, list kit name, then list kit components individually

Manufacturer ♦Name on product & MSDS must match

Process Type 5

Container Size & Type 6

Initial Quantity 7

♦Number of containers

PSNS & IMF

MSDS

♦For approved material only

PSNS & IMF

Product ID

♦Or reason for disapproval Add Use Waste Move off-site

PSNS&IMF 5090/132 (Rev. 7-06) (Front) Legend: COR – Contracting Office Representative/ HM – Code 106.34 HAZMAT Process Management Branch

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I N S T R U C T I O N S

Contractor: Complete sections titled “Contractor” per instructions and footnotes. List all hazardous material (HM), including Government Furnished Material (GFM), brought into the Bremerton Naval Complex by the contractor. Note: Do not list GFM that has been both labeled with a barcode and issued at the local Hazardous Material Control Center (HMCC) in Bldg. 997. Use continuation sheet(s) if necessary. Hazardous materials are materials that may pose a hazard to human health or the environment, including materials that may present a risk of exposure when cutting or processing (e.g., wood, metal, welding rod, thermal insulation). Submit the completed CHMI form to Code 106.34 through the Contracting Officer or designated representative. Include a Material Safety Data Sheet (MSDS) for each hazardous material listed on the CHMI form. Provide a Volatile Organic Compound (VOC) certification sheet or other acceptable VOC documentation for all marine coatings.

* Contractor Certification Statement: I hereby certify that the submitted information contained in the attached document(s) is both accurate and complete based on reasonable estimates and that Code 106.34 HAZMAT Process Management Branch has approved all material listed in the monthly and final usage report.

Contracting Officer (Government) Representative: Complete section titled COR. Ensure HM is approved by Code 106.34 before the contractor brings it into the Bremerton Naval Complex.

Code 106.34 HAZMAT Process Management Branch: Complete sections titled HM. Evaluate HM for use at PSNS & IMF and Naval Base Kitsap - Bremerton. Assign authorized HM a PSNS & IMF MSDS number and a unique PSNS & IMF Product ID number that identifies specific information about each HM such as size, color, type, grade, etc.

F O O T N O T E S

1. Check applicable box to identify request type. Identify month/year for both monthly and final reports. Monthly HM usage report is due by the 5th calendar day of the following month.

2. Identify Project (e.g., ship hull number or name, etc.).

3. Identify Worksite Location (e.g., Bldg. 431 5th floor, Dry Dock 2, Pier Delta, etc.).

4. Provide a separate line for each container size that will be used. When reporting kits, identify the kit on one line and list each component on subsequent lines. Report unkitted base or accelerator separately. Reference example below.

Trade Name Manufacturer Process Code

Container Size & Type

Initial Qty Add Use Waste Move

Offsite Amercoat

235 Ameron ID0606 1 gal KT 5 5 7 3

Buff Base " " 0.8 gal CN Converter " " 0.2 gal CN 2190TEP Castrol ID2304 1 qt BT 24 0 20 1 2

5. See Table 1 – List Code. If not listed, specify process.

6. Report container size as either a weight or volumetric unit such as 3 lbs, 16 fl oz, etc. A box or a spool is not a quantifiable unit. For kits, list both the kit size and each individual component size.

Reference Footnote 4 for reporting kits. List container type – See Table 2.

7. For new CHMI requests, list the initial quantity of material that will be brought on-site. This is the number of containers you will bring in for the specified container size, once approved.

8. Monthly Reporting: Record inventory (number or fraction of containers) added, used, wasted, or moved off-site for the reporting month. For kits, report the number or fraction of kits in lieu of individual components. Reference example on the left.

TABLE 1 - PROCESS TYPES TABLE 2 - CONTAINER TYPE

CODE TYPES OF PROCESS CODE TYPES OF PROCESS CODE CODE DESCRIPTION

CP0101 Routine Janitorial ID0510 Industrial Paint– Thinning/Pigment SR1099 Internal Combustion (small 2/4 cycle) AER Aerosol Can ID0599 Non-Industrial Paint – Architectural/Traffic ID0601 Marine Coating – Dip Tank ID0206 Degreasing – Wipe Cleaning AM Ampule ID2301 Industrial Equipment – Minor Maint ID0603 Marine Coating – Brush/Roller ID0208 Safety-Kleen BG Bag SR0100 Motor Vehicle Fuel or Maintenance ID0604 Marine Coating – Spray Booth ID0215 Chemical Gauge Cleaning BL Barrel SR0500 Grounds Maintenance ID0606 Marine Coating – Spray Exterior ID0301 Ultrasonic Cleaning BX Box SR0200 Mobile Equipment/Crane Maintenance ID0607 Marine Coating – Powder ID0500 Paint, Solvent, & Clean-up CA Cartridge SR0300 Pest Control ID0608 Marine Coating – Spray Interior ID0508 Paint Stripping (organic solvent) CL Coil SR0400 Facility Maintenance ID0609 Marine Coating – Spray Interior Tank ID0108 Grinding CN Can ID0100 Abrasive Blast Grit (specify media) ID0610 Marine Coating – Thinning/Pigment ID0109 Polishing & Buffing CO Container ID1103 Welding, Oxyfuel ID0661 Marine Ctg – (Low Use) Dip Tank ID1000 Machining Fluids CY Cylinder ID1108 Shielded Metal Arc (SMAW) ID0663 Marine Ctg – (Low Use) Brush/Roller ID1100 Torch Fuel (e.g.- butane, acetylene) DR Drum

R E F E R E N C E

ID1109 Gas Metal Arc (GMAW) ID0664 Marine Ctg – (Low Use) Spray Booth ID1105 Brazing/Solder (fillers/flux) EA Each ID1110 Gas Tungsten Arc (GTAW) ID0666 Marine Ctg – (Low Use) Spray Exterior ID1403 Non-Destructive Test JR Jar ID1115 Flux Core (FCAW) ID0668 Marine Ctg – (Low Use) Spray Interior ID2202 GFE Instrument Calibration KT Kit ID1302 Cutting, Oxygen ID0669 Marine Ctg – (Low Use) Spray Int. Tank ID2300 Industrial Equip – Fabrication/Repair PG Package ID1306 Cutting, Carbon Arc ID2000 Adhesive/Sealant – New Furniture Mfg. ID2303 Marine Repair – Sealed Systems PZ Packet ID0502 Industrial Painting – Spray ID2313 Adhesive/Sealant – Non-Aerosol ID2304 Marine Assembly Repair RD Rod ID0504 Industrial Painting – Powder ID2399 Adhesive/Sealant – Aerosol SR0699 Fire/Rescue/Spill SP Spool ID0505 Industrial Painting – Brush/Roller SR1000 External Combust Boiler – Utilities CN0899 Construction – Paving TK Tank ID0506 Industrial Painting – Dip SR1090 External Combust – Portable Heater CN0100 Structure Fabrication TU Tube ID0507 Industrial Painting – Aerosol SR1091 Internal Combust – Diesel CN0500 Structure Demolition VI Vial

T A B L E S

ID0509 Industrial Painting – New Furniture Mfg. SR1098 Internal Combust – Gasoline (Large) Other Specify Process Description Other Specify Description PSNS&IMF 5090/132 (Rev. 7-06) (Back)

WASTE INFORMATION SHEET (WIS)

PSNS&IMF 4855/612 (Rev. 4-06) (Front)

Ref: PSNS&IMFINST P5090.5

WASTE INFORMATION SHEET (WIS) SERIAL NO.

SECTION I (Waste Originator) Complete a separate WIS for each type of waste.

Full instructions are provided on reverse side. Shaded sections MUST be completed by originator.

1. ORIGINATOR (Shop, Ship, Code, Contractor): 2. PROJECT/SHIP (Hull#/Name): 3. LOCATION (Bldg, Pier, etc.):

4. POINT OF CONTACT (Name): 4a. PHONE: 5. GOV’T POC (Contractor’s Only):

6. WASTE NAME ( DESCRIPTION): 7. WASTE PRODUCED IS:

One-Time Waste Process Waste Unused Materials

7a. Total Waste Quantity (approx qty/#containers/container size):

8.WASTE STREAM NO. (if known):

9. PRE-DESIGNATED WIS SER. NO. PHYSICAL STATE AND COLOR:

(solid, liquid, sludge, aerosol, red, etc.)

11. HOW WASTE WAS MADE (Specific process which created this waste; include any applicable work document#, IPI, Contract#, MILSPEC, etc.):

12. MSDS NO. 13. MATERIAL/TRADE NAME 14. NSN/PART NO. 15. MFG/W/PHONE NO. 16. % OF WASTE

17.OTHER POTENTIAL CONTAMINANTS (Either check or include approx. concentration): Lab Analysis #______________________(if applicable) ______ ASBESTOS _______ PCBs _______ METALS _______SOLVENTS _________OIL ________ OTHER__________________________

18. DISPOSITION TO BE PERFORMED BY (Contractors only): PSNS & IMF Contractor-Arranged (Enter proposed transporter & disposition facility)

TRANSPORTER COMPANY (Name & phone number) __________________________________________________________________

DISPOSITION FACILITY (Name & phone number) _____________________________________________________________________

19. ORIGINATOR’S SIGNATURE, BADGE NO./RANK, PRINTED NAME, AND DATE CERTIFYING THE ABOVE NAMES MATERIALS ARE THE COMPOUNDS IN THE WASTE CONTAINERS

LISTED BELOW AND HAVE NOT BEEN MIXED WITH OTHER MATERIALS.

(Sign) _______________________________________ (Print) ___________________________________________

(Badge No./Rank)________________________________________

SECTION II - CONTAINER INFORMATION (Originator complete Barcode, Cont. Type, and Start Date (columns only)

ITEM

NO.

ID LABEL

BARCODE NO.

CONT. TYPE

& CAPACITY

WEIGHT

(LBS)

OPEN & INSPECT

(Initials)

START DATE

(N/A for Non- Haz Wastes)

STORAGE

SECTION

LAB ANALYSIS

NO.

SECTION III - SHOP 90HM RECEIPT/INVENTORY

20. INSPECTION SAT? (Circle One):

YES NO (Explain in “REMARKS”)

20a. INSPECTOR’S INITIALS: 21. DELIVER TO:

22. TRANSPORTED BY (Signature & Date): 23. RECEIVED BY (Signature & Date):

SECTION IV - WASTE DISPOSITION BY CODE 106.34 24. If WSN in Block 8 is correct & tech resolution not required, check this box.

25. WSN ASSIGNED: 26. DATE: 27. DESIGNATOR’S SIGNATURE: 28. PROFILE:

29. LABELS/PPE: 30. DISPOSITION: Reutilize Recycle Trash HW, PCB Asbestos Other _____________________

31. REMARKS: Landfill Controlled - WDA #: ___________________________________

Page 1 of _______ PSNS&IMF 4855/612 (Rev. 4-06) (Front) Routing: White: Shop 90HM Pink: Data Entry Blue: Handlers Yellow: Originator

Section H, Attachment (2)

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(Rear)

WASTE INFORMATION SHEET (WIS) INSTRUCTIONS

GENERAL: THIS PAGE PROVIDES BLOCK-BY-BLOCK INSTRUCTIONS FOR THE ORIGINATOR. NOTE THE FOLLOWING: Shop 90HM has discretion in completeness of shaded portions of WIS during waste turn-in process.

• Originators are to complete all sections that are shaded in gray. Enter “N/A” if a block is not applicable.

• A Job Order Number must be provided on all WISs turned into Shop 90HM. A section is provided in the upper-right-hand corner of the form for the Job Order Number. WISs will not be accepted without a Job Order Number.

• Please write legibly and press hard enough to clearly imprint on all copies.

SECTION I

1. ORIGINATOR - This is the organization which is directly creating the waste material. Examples: “C/350,” “S/72,” “ACME Painting.”

2. PROJECT/SHIP - Enter the general project or job that is creating the waste. Examples might include: “CVN-72,” “BEQ construction,” “Farragut Ave repair,” “S/71” (used in the case of general Shop work).

3. PROJECT LOCATION - Record the location where the process occurred that created the waste. Be as specific as possible. Examples include: “sump room - Bldg. 427,”

“south end DD3,” “corner of Huey and Duey St.”

4. ORIGINATOR POINT OF CONTACT - Write the name of the person who is sufficiently knowledgeable to answer questions concerning the waste generation process. This person may be military, civilian, or contractor.

4a. PHONE – List the phone number for the primary point of contact listed in Block 4. If this is not a Shipyard phone number, include the area code.

5. GOV’T POC - THIS BLOCK IS FOR CONTRACTORS ONLY! List a government point of contact. This is the government person who is the Contracting Officer’s

Representative.

6. WASTE NAME (DESCRIPTION) - This block should be the same as, or very similar to, the “MATERIAL CONTENTS” section of the ID label located on the waste container.

7. WASTE PRODUCED IS- Select the appropriate box for the waste you are originating. “One-time-waste” means waste will not be generated again. “Unused materials” means material that is excess, expired, or unwanted. “Process waste” means waste that was generated by an ongoing industrial process.

7a. TOTAL WASTE QUANTITY – List the actual amount of material to be shipped now. The quantity should be described in terms of the smallest container contained in the transport package. For example, a 5-gallon drum full of tubes might say “63 – 25 oz. tubes” whereas a 55-gallon drum full of liquid would simply say “1 55-gal drum”.

8. WASTE STREAM NUMBER - If the waste has an established waste stream number, write the number here. If the waste is a new waste stream or if you are not sure, leave the block “blank”.

9. PRE-DESIGNATED WIS SER. NO. – Enter the pre-designation WIS serial number in this block, if known. Otherwise enter “N/A”.

10. PHYSICAL STATE AND COLOR- Describe the waste from a standpoint of what you would see, smell, and/or feel if you were to open the waste and look at it. Examples might include “thick brown sludge” or “clear oily liq w/banana scent” or “white paste in tubes.”

11. HOW THE WASTE WAS MADE - Describe the process that created the waste. Be as specific as space allows. Examples might include “mild steel water jet cutting” or

“removal of dirt, Phys Fitness Center” or “wiping grease from arresting gear cables” or “excess from pattern gluing.” The words “excess” and “expired” are not processes.

Use these words in conjunction with the process for which they were intended. Indicate the document that governs the work process generating the waste. This might be a contract, an IPI, a MILSPEC, as ASTM, an instruction, or any other type of document.

12. MSDS NO. - List the Material Safety Data Sheet number or numbers for hazardous materials that make up the waste.

13. MATERIAL/TRADE NAME - Write the material or trade name of the product in this block.

14. NSN/PART NO. - List the stock number(s) of the material(s) that make up the waste. If the material(s) were obtained through the Federal Supply System, include the FSN and the NIIN if known.

15. MFG/W/PHONE NO. - Indicate the manufacturer of the material that makes up the waste (Including phone number).

16. % OF WASTE – Write an approximate percentage of the material used in proportion to the waste originated.

17. OTHER POTENTIAL CONTAMINANTS/LAB ANALYSIS # - Indicate potential contaminants that you believe MAY be in the waste (include approximate concentration, if known). List Lab Analysis number, if applicable.

18. DISPOSITION PERFORMED BY - THIS SECTION IS FOR CONTRACTORS ONLY. Check “PSNS & IMF” if your contract states to turn your waste over to the Shipyard for disposal. Check “Contractor-Arranged” if you will be disposing of the waste using non-government resources. If “Contractor-Arranged” is checked, indicate the name and phone number of the planned transporter and disposition facility.

19. ORIGINATOR’S SIGNATURE - This is the person authorized by the originator’s command or company to request and sign for HW commitments, as well as having knowledge of the waste sufficient to certify an accurate waste description.

SECTION II

“ID LABEL BARCODE NO” column - Enter the ID Label Barcode Number of each container of waste. PLEASE WRITE CLEARLY. If you have more than 5 containers use a continuation sheet(s) or additional WIS(s).

“CONT. TYPE & CAPACITY” column - Enter the type and capacity of each container being shipped. The following codes may be used to abbreviate some container types.

“START DATE” column – Enter the Start Date from Hazardous Waste or Washington State Dangerous Waste label on the container. Leave “blank” if the waste is Waste Awaiting Designation (WAD).

CODE TYPE CODE TYPE CODE TYPE

CY Cylinder DF Fiber drum or plastic drum

DT Dump Truck

Fiber box or carton Metal drum Portable Tank

EXAMPLE - “55g DM” is a 55-gallon metal drum, “5g Can” is a 5-gallon can.

PSNS&IMF 4855/612 (Rev. 4-06) (Back)

CONTRACTOR'S SOLID WASTE TRACKING SHEET (SWTS)

(FOR ALL DISCARDED ITEMS DESIGNATED BY THE GOVERNMENT AS NOT HAZARDOUS WASTE, PCB, OR ASBESTOS) Ref: NAVSHIPYDPUGETINST P5090.11

SECTION I WASTE ID (The numbers shown in bold italics correspond to the blocks on the WIS.) Load Number

SWTS # Waste Stream Number (WSN) [25] Government Prefix Waste Information Sheet (WIS) Serial Number

-- Leave blank until copies of original have been made.

Waste Description [6] Attach weight ticket here

Directed Disposition [30] (Check applicable box) Waste Disposal Application Number

Landfill-Controlled Enter WDA

Reutilize (Reuse) Recycle Trash Other

When scales are not available at place of delivery, enter number of cubic yards.

This number will be used by you to calculate weight for the ry.summaSECTION II CONTRACT NUMBER/TITLE (Contractor completes Sections I thru V; see instructions on back.)

Contract Number Contract Title

Government Point of Contact (Enter the name and phone number of the Government POC monitoring this contract.) Phone

SECTION III FINAL DESTINATION (Obtain from WIS block [17] and your Government-approved Environmental Plan.)

Permit Type and Number (if applicable)

Facility Name Phone

Facility Owner

Facility Address (Complete physical address only)

SECTION IV FINAL DISPOSITION (To be completed by the Contractor)

(Check applicable disposition box)

Waste will be taken to the Section III address to be: REUTILIZED REYCLED DISPOSED

STOP! Make enough copies of this original to match the estimated number of loads to be transported. Number the first copy "01." If there will only be one load, use this original instead of a copy. DO NOT USE THIS FORM FOR waste designated as ASBESTOS, PCB, or HW.

SECTION V CONTRACTOR VERIFICATION (To be completed by the Contractor)

(Check applicable description box)

I hereby verify that the contents in this: Container Truck Roll-off Box Other have been inspected by me and are as described in Section II and the WIS. No additional waste has been added.

Contractor's Signature Date

SECTION VI TRANSPORTER VERIFICATION (To be completed by the Driver of the transport vehicle)

I hereby verify the following:

a. No material or waste was added or removed after loading and verification signature at the work site, and

b. I delivered the load contents as stated to the address stated in Section III.

Transporter's Signature Date

SECTION VII RECEIVER SITE VERIFICATION (To be completed by the Receiver)

I hereby verify I received the load contents as described in Section II at the address stated in Section III.

(Note: Approved receiver sites for soil reuse are sometimes unattended. In this case, Transporter completes.)

Receiver's Signature Print Name Date

ALL INFORMATION AND SIGNATURES MUST BE LEGIBLE.

This form shall be completed for each load. See reverse side for explanation of disposition descriptions and form instructions. The data will be compiled and summarized by the Contractor on the CONTRACTOR'S MONTHLY PROJECT WASTE SUMMARY REPORT, PSNS 5090/113.

PSNS 5090/114 (Rev. 6-01) (Front)

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CONTRACTOR’S SOLID WASTE TRACKING SHEET (SWTS)

(FOR ALL DISCARDED ITEMS DESIGNATED BY THE GOVERNMENT AS NOT HAZARDOUS WASTE, PCB, OR ASBESTOS)

DISPOSITION DESCRIPTION

NOTE: All discarded items require designation. This form cannot be completed until a Waste Information Sheet (WIS) has been completed by the Contractor and approved by Shipyard Shop 90HM.

Exceptions: Sanitary wastes and organic decaying debris.

“Reutilize” Items which contractually belong to the Contractor may be removed by the Contractor to his place of business, or may be offered to the Government for reutilization (reuse). Examples: Kitchen and lavatory items, concrete barriers.

NOTE: Although soil does not belong to the Contractor, there is a potential for reuse of soil off-site IF:

Upon completion of waste designation by the Government, the WIS states that potential, AND The Contractor obtains approval of the receiving county’s Health District Officials.

“Recycle” Take to a facility (or broker) where there is a process to remanufacture the discarded item into another usable item.

Examples: Cardboard/paper, asphalt, wood, concrete.

“Landfill-Controlled” Landfills are required to have a process in place to screen the waste they receive. A “Landfill-Controlled” waste is any waste for which the receiving facility requires a landfill disposal application to ensure the waste is screened in a way that meets the requirements of their operating permit. Examples: Soil, painted wood waste. If you check this category, enter the Waste Disposal Application (WDA) number on the line provided to the right of the “Landfill-Controlled” category box.

“Trash” or “Non-Hazardous to Trash” Discarded items which:

Have not been designated as “Hazardous Waste (HW),” “PCB,” or “Asbestos;”

Do not require a Waste Disposal Application; and Are unable to be recycled.

INSTRUCTIONS

CONTRACTING OFFICER: Fill in the “Government Prefix” block with your organization’s ID – do not exceed 5 letters (i.e., “ROICC”).

CONTRACTOR: With the exception of the “Load Number” block, fill out Sections I - IV. This will be the base form for all loads of this designated waste stream. Next, estimate the number of loads it will take to remove the waste, and make the same amount of copies of the semi-completed form as the load estimate. Contractor will then assign load numbers in the “Load Number” block for the purpose of tracking each load of waste to its final destination. Number each page consecutively, beginning with the number “01” -- refer to “Sample Scenario.” If there will be only one load of this waste stream on the project, use the original instead of making copies. Each time a load of waste is put into the transport vehicle, the Contractor verifies the waste, signs, and completes Section V.

TRANSPORTER: Verify, sign, and complete Section VI. Obtain a load weight ticket. If no one is present at the receiving site, complete Section VII.

RECEIVER: Verify, sign, and complete Section VII. Provide weight ticket and return signed SWTS to Transporter. If scales are not available, enter number of cubic yards of the load on the line provided for the weight ticket.

TRANSPORTER: Attach the load weight ticket to the SWTS. Return SWTS and weight ticket to Contractor.

CONTRACTOR: If the receiving facility did not provide a weight ticket, ensure the number of cubic yards has been recorded on the line provided. Retain SWTS until the end of that calendar month for compilation into the Contractor’s Monthly Project Waste Summary Report (CMPWSR), PSNS 5090/113. Submit all SWTS and the CMPWSR forms in a package to your Government POC.

Sample Scenario: XYZ Co. is excavating soil during a Government project, and has submitted Waste Information Sheet (WIS) #654321 to Shop 90HM for waste designation. When returned, the WIS shows the soil has been designated as “Landfill-Controlled” waste. XYZ Co. completes the additional form (Waste Disposal Application) required by the landfill. They obtain a SWTS from their Contracting Officer, who has already filled in the “Government Prefix” block. XYZ Co. copies the serial number of their WIS for soil from this project to the SWTS. (These two blocks comprise the SWTS serial number). They then transfer the required information from their WIS, completing Section I. Next they identify the project information for Section II. Moving to Section III, they enter the Government-approved facility location the soil will be taken to, and check “disposed” as its final disposition. They estimate 1,000 cubic yards of soil will be removed during the project, which will take approximately 50 truckloads. XYZ Co. makes 50 copies of the SWTS #ROICC-654321 original; and then assigns each copy a number, beginning with Load “#01” and ending with “#50.” When the soil transportation begins, XYZ Co. gives “SWTS #ROICC-654321, Load #01” to the driver of the first load of soil, “SWTS #ROICC-654321, Load #02” to the driver of the second load, etc. Before each load leaves the work site, XYZ Co. verifies that the content of each load is indeed what is described in Section I. As each driver delivers their load, they verify that they transported only that specified waste to the approved facility. The receiver at the disposal facility acknowledges receipt of the load with his signature, and provides the transporter with the load weight ticket. The driver submits the weight ticket and the completed SWTS to XYZ Co. Monthly, XYZ Co. submits all completed SWTS documentation for the prior month, and a completed CMPWSR summarizing the data.

PSNS 5090/114 (Rev. 6-01) (Back)

CONTRACTOR'S MONTHLY PROJECT WASTE SUMMARY REPORT (CMPWSR)

Ref: NAVSHIPYDPUGETINST P5090.11

CONTRACT NUMBER:

CONTRACT TITLE/DELIVERY ORDER:

CONTRACTOR:

GOVERNMENT POINT OF CONTACT’S NAME: PHONE:

REPORTING DATES: From / / To / /

CHECK HERE IF NO WASTE ORIGINATED FROM YOUR PROJECT THIS MONTH

Discarded items were: (Refer to the SWTS, Section II. Check the applicable disposition box and enter the discarded items as described.)

SWTS

SERIAL #

LOAD

NUMBERS

POUNDS

See * footnotes below

Example: ROI2002- Asphalt Reused Recycled Disposed 234567 4-7 10,457

1. Reused Recycled Disposed

2. Reused Recycled Disposed

3. Reused Recycled Disposed

4. Reused Recycled Disposed

5. Reused Recycled Disposed

6. Reused Recycled Disposed

7. Reused Recycled Disposed

8. Reused Recycled Disposed

9. Reused Recycled Disposed

10. Reused Recycled Disposed

11. Reused Recycled Disposed

12. Reused Recycled Disposed

13. Reused Recycled Disposed

14. Reused Recycled Disposed

15. Reused Recycled Disposed

* For waste soil where no scales are available at place of delivery, calculate 2600 pounds per cubic yard removed.

** For common trash which has been collected by a disposal transporter and combined with others' trash in the truck, estimate

250 pounds per cubic yard. Base your estimate on how many cubic yards were removed, NOT the size of the box.

FINAL REPORT:

CHECK HERE IF YOUR PROJECT/DELIVERY ORDER IS COMPLETE AND THIS IS THE LAST REPORT

NOTE: The SOLID WASTE TRACKING SHEET (SWTS), PSNS 5090/114, describes each load removed from the Bremerton Naval Complex by the Contractor or subsequent Sub-Contractors, and is used as a custody sheet to track all discarded items which have been designated by the Government as not Hazardous and do not contain PCBs or Asbestos. This report is a monthly summary of the SWTSs for this project.

(SEE REVERSE SIDE FOR INSTRUCTIONS)

PSNS 5090/113 (Rev. 07-02) (Front)

X

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CONTRACTOR’S MONTHLY PROJECT WASTE SUMMARY REPORT (CMPWSR)

INSTRUCTIONS

DO NOT USE THIS FORM AS A SUMMARY FOR

HAZARDOUS WASTE OR WASTE CONTAINING PCBs OR ASBESTOS

CONTRACTOR:

a. Complete and accumulate all Solid Waste Tracking Sheets (SWTSs) each month for the duration of the project. At the end of each calendar month, compile requested data from the SWTS and complete the Contractor’s Monthly Project Waste Summary Report in the manner shown in the shaded example. Note that the reporting unit is “POUNDS.” If no waste originated from the project this month, or if this is the last report for the project, check the applicable boxes.

b. Submit the report no later than the fifth calendar day of the following month, along with all SWTS originals referenced in the report, to the Contracting Officer. If no waste transport activity has occurred during the month, check the applicable box and submit the report reflecting negative activity for that time period.

c. When a project ends in mid-month, submit the Contractor’s Monthly Project Waste Summary Report reflecting only the work activity which occurred from the first calendar day of that month to the project’s completion. Check the applicable box reflecting last report. Submit the final report, along with all SWTS originals referenced in the report, to the Contracting Officer prior to project close-out.

GOVERNMENT CONTRACT POINT OF CONTACT:

a. Forward a copy of the Contractor’s Monthly Project Waste Summary Report to Code 106.33, Solid Waste Program Manager, on a monthly basis.

b. Maintain all SWTSs in the permanent project file or, at the agency’s discretion, submit the SWTSs along with the Contractor’s Monthly Project Waste Summary Report to Code 106.33, Solid Waste Program Manager, each month.

CODE 106.33:

a. Record all data submitted on the Contractor’s Monthly Project Waste Summary Report.

b. Include this information in the Solid Waste Annual Report.

PSNS 5090/113 (Rev. 07-02) (Back)

EMERGENCY RESPONSE

PROCEDURES Ref: PSNS&IMFINST 5090.1

1. EVACUATE the building or area if required to an upwind and upgraded area.

Notify any other personnel in the area.

2. AT THE BREMERTON SITE:

NOTIFY THE REGIONAL DISPATCH CENTER (RDC)

BY DIALING "9-1-1".

If calling from a cellular phone, call:

a. Bremerton site (360) 476-3333

b. Bangor site (360) 396-4444

c. Everett site (425) 304-3220

3. REPORT THE FOLLOWING INFORMATION as applicable:

a. Name, Organization, Phone Number

b. Type of Emergency (Fire, Spill, Flooding, etc.)

c. Location of Emergency

d. Hazardous Substance(s) Involved

e. Corrective Actions Taken (if any)

f. Any Other Relevant Information (operations in the area, storm drains involved, area of ship affected, etc.)

Do not hang up the telephone until instructed to do so by the dispatcher.

4. AVOID CONTACT with any spilled material without proper knowledge of hazards and appropriate personal protective equipment.

5. IF POSSIBLE:

a. Remove Injured

b. Extinguish Flame or Contain Spill

c. Cover/Protect Drains

d. Use Spill Kit

6. REMAIN AT A SAFE DISTANCE AND REPORT TO THE INCIDENT COMMANDER

(FIRE CHIEF) to direct emergency response personnel and provide information.

Supervisor/Point of Contact for Area

Phone Number Nearest Fire Alarm

PSNS&IMF 5090/9 (Rev. 11-06)

JH.1-5

Personal Information for Visitor Request

PLEASE PRINT LEGIBLY

SOCIAL SECURITY NUMBER

LAST NAME

FIRST NAME

MIDDLE INITIAL

HOME PHONE

HOME ADDRESS

CITY

STATE

ZIP CODE

YES PROOF WILL BE REQUIRED WHEN BADGE IS ISSUED

Acceptable documents: Birth Certificate with a Raised Seal or U. S. Passport or original Certificate of Naturalization or FS-240 Certificate of Person Born Abroad

U. S. CITIZEN

NO IF NON-CITIZEN PLEASE STATE COUNTRY OF CITIZENSHIP:

SEX MALE FEMALE

DATE OF BIRTH

PLACE OF BIRTH – CITY

PLACE OF BIRTH – STATE

COMPANY

COMPANY ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

CONTACT/DEPARTMENT

F COMPANY IS A SUB-CONTRACTOR,

STATE PRIME CONTRACTOR’S NAME

THE INFORMATION PROVIDED IS “FOR OFFICIAL USE ONLY” AND WILL BE MAINTAINED IN CONFIDENCE.

JH.1-6

Ref: NAVSHIPYDPUGETINST P5239.2

COMPANY OR ACTIVITY NAME ARRIVAL DATE DEPARTURE DATE

MFG & MODEL ID SERIAL NUMBER OPERATING SYSTEM TYPE

(i.e. , Windows 2000, Linux, MAC, etc.)

AUTHORITY TO OPERATE ON PUGET SOUND NAVAL SHIPYARD AND INTERMEDIATE MAINTENANCE FACILITY (PSNS & IMF) BREMERTON SITE

I certify that this system is owned by a company under contract with the U.S. Government or is owned by the U.S. Government.

I understand that personally owned computers and peripherals are not authorized at PSNS & IMF and are not covered by this Authority to Operate.

I understand that while at PSNS & IMF site I will not connect to the PSNS & IMF Local Area Network. I will ensure that daily virus scan of memory and all storage media is performed before conducting any use of this system and that all removable media will be identified with appropriate sensitivity labels. A copy of this Authority to Operate shall accompany the system at all times while at PSNS & IMF.

DATE: _____________________________________ SIGNATURE: ________________________________________________________

PHONE NUMBER: ____________________________ PRINTED NAME: ________________________________________________________

DATA SENSITIVITY

INDICATE THE SENSITIVITY LEVEL OF THE INFORMATION STORED ON THE SYSTEM BY PERCENTAGE (MUST TOTAL 100%):

LEVEL PERCENT YES NO (IF YES, EXPLAIN IN COMMENTS BLOCK, BELOW.)

COMPANY (NON-NAVY DATA) _______% WILL THE MODEM BE USED TO CONNECT TO ANY

NETWORK? IF YES, EXPLAIN BELOW (COMMENTS).

UNCLASSIFIED _______%

DOES THE LAPTOP HAVE A WIRELESS CARD?

SENSITIVE UNCLASSIFIED _______%

WILL THE WIRELESS CARD BE USED TO CONNECT

FOUO _______% TO ANY NETWORK? IF YES, EXPLAIN BELOW (COMMENTS).

PRIVACY ACT _______% DOES THE LAPTOP HAVE AN ETHERNET CARD?

NNPI/NOFORN _______% WILL THE ETHERNET CARD BE USED TO CONNECT

TO ANY NETWORK? IF YES, EXPLAIN BELOW (COMMENTS).

CONFIDENTIAL _______%

DOES THE LAPTOP HAVE BLUETOOTH CAPABILITY?

SECRET _______%

IS THIS AN NMCI-NNPI ASSET (UNDER THE NNPI COI)?

COMMENTS: ___________________________________________________________________________________________________________________

ALL USERS HAVE SECURITY CLEARANCE EQUAL TO OR HIGHER THAN THE HIGHEST LEVEL OF

INFORMATION ON THE SYSTEM AND A NEED-TO-KNOW FOR ALL OF THE INFORMATION.

REQUESTOR’S FAX NUMBER: ( ) _______ -- ____________

SIGNATURE OF PERSON VALIDATING SECURITY CLEARANCE: _________________________________________________________________

PHONE NUMBER: ______________________________ PRINTED NAME: ________________________________________________________

WHEN APPROVED, A COPY OF THIS FORM SHALL ACCOMPANY THE EQUIPMENT AT ALL TIMES WHILE AT PSNS & IMF.

OWNING ORGANIZATION

ADDRESS

OWNING ORGANIZATION

POINT OF CONTACT

OWNING ORGANIZATION

TELEPHONE NUMBER

PSNS & IMF CODE/SHOP SUPPORTED PSNS & IMF PROJECT NAME

AND LOCATION OF SYSTEM

(BUILDING OR AREA)

PSNS & IMF LOCAL POINT OF CONTACT

PROJECT: LOCATION: NAME: (REQUIRED) PHONE: (REQUIRED)

PSNS & IMF APPROVAL TO OPERATE DATE

I hereby grant authority to operate this system on PSNS & IMF during the period specified and under the conditions specified above.

Code 1234, (360) 476-9949, Fax (360) 476-2049 PSNS&IMF 5239/49 (Rev. 2-07)

JH.1-7

JH.1-8

RADIO OPERATIONS REQUEST Ref: PSNS&IMFINST 2400.1

PLEASE PROVIDE THE FOLLOWING INFORMATION

REQUESTING COMPANY NAME ADDRESS PHONE NUMBER

NAME OF PERSON MAKING REQUEST TITLE PHONE NUMBER

JUSTIFICATION FOR USING RADIO EQUIPMENT AT PSNS & IMF/NAVBASE KITSAP - BREMERTON

LOCATION WHERE EQUIPMENT WILL BE USED DATES OF REQUESTED OPERATION

NAME OF ON-SITE SUPERVISOR OR CUSTODIAN RESPONSIBLE FOR THE USE OF THE RADIO EQUIPMENT PHONE NUMBER

FCC LICENSE CALL SIGN (NOTE: PROOF OF FCC OR NTIA AUTHORIZATION IS REQUIRED. ATTACH A COPY OF STATION LICENSE.)

EQUIPMENT

(If more than one type equipment is to be used, attach additional information to the back of this form.)

MANUFACTURER’S NAME TYPE OR MODEL NUMBER EMISSION TYPE (I.E., AM, FM, DATA)

NUMBER OF TRANSCEIVERS TO BE USED RF WATTAGE OUTPUT RADIO FREQUENCY(IES) TO BE USED

NAME OF NAVY SPONSOR (I.E., ROICC, COTR) CODE PHONE NUMBER

REQUESTOR’S SIGNATURE DATE

INSTALLATION SPECTRUM MANAGER’S APPROVAL (SIGNATURE) DATE

PSNS&IMF 2400/2 (2-06)

JH.1-9

Contractor’s Guide to

B

Puget Sound Naval Shipyard and Intermediate Maintenance Facility and Naval Station Bremerton Bremerton, Washington PSNS&IMF P5090 (4) (Rev. 11-03)

Bremerton Naval Complex

Contract Specification

Environmental Compliance

JH.1-10

Contractor’s Guide to Environmental Compliance

ABOUT THIS GUIDE

The Contractor’s Guide to Environmental Compliance at Puget Sound Naval Shipyard and Intermediate Maintenance Facility (PSNS & IMF) and Naval Station Bremerton, herein referred to as the Bremerton naval complex (BNC), is designed to meet the environmental information needs of contractors working at the BNC. This is also a useful tool for other personnel (e.g., contracting officers and design managers) who will very likely find themselves confronted with one or more environmental issues.

Throughout this guide, the term "Contracting Officer" also includes the representatives of the Contracting Officer.

This guide is the second revision. The revision was made to recognize the stand up of the Environmental Office at Naval Station Bremerton. Some programs are managed in parallel for the respective facility. The revision also replaces the information for contractors to attend a station specific three day course HW-39, with a two hour briefing, for an accumulation area operator. Puget Sound Naval Shipyard integrated with Intermediate Maintenance Facility Northwest and is now named Puget Sound Naval Shipyard and Intermediated Maintenance Facility (PSNS & IMF). This guide is only applicable to the Controlled Industrial Area (CIA) of the shipyard and Naval Station (NAVSTA) Bremerton. The term “shipyard” will be used to clarify that portion of PSNS & IMF. The term Bremerton naval complex (BNC) is used to include both the shipyard and NAVSTA Bremerton.

ENVIRONMENTAL

COMPLIANCE

EPA WDOE PSCAA

Puget Sound Naval Shipyard and Intermediate

Maintenance Facility Naval Station Bremerton

Intended as a “primer” on environmental regulations and BNC policies and procedures, this guide is structured around questions you need answered in each media (e.g., air, water, waste, etc.) and issues you need to know about.

The information provided in this guide offers the level of detail needed for basic knowledge of key environmental issues. This knowledge will help you develop and maintain the most efficient and effective Environmental Program possible while performing your task. If there are any questions regarding an environmental regulation, or in the event of an emergency, please contact the Contracting Officer.

Telephone numbers for the BNC's designated points of contact are provided on the next page and back cover of this pamphlet, for the contracting officers use. These individuals are not authorized to provide direction to contractors.

We wish you environmental success on this project and in the future!!!

Disclaimer: Each contractor is responsible for compliance with all contractual requirements, including compliance with all applicable Federal, State, and local environmental requirements, as well as Bremerton naval complex environmental requirements as specified in the contract. This document is provided for general awareness only. It remains the contractor’s duty to comply with all applicable laws, and this guide alone cannot assure such compliance. To the extent the requirements of this document are in direct conflict with the contract specifications, the contract specifications control. If the contractor believes this guidance conflicts with the contract specifications, the issue should be discussed with the Contracting Officer in order to avoid violating relevant environmental laws.

Bremerton naval complex i

TELEPHONE LISTING

EMERGENCIES (Medical Assistance, Fire, Flooding, Emergency Spill Response, etc.):

When using a BNC telephone When using a non-BNC telephone system ................................................................ 360-476-2222

CONTRACTING OFFICES

EFA-NW Bremerton ROICC, Building 467 .............................................................. 360-476-8130 or 360-476-4552 EFA-NW Silverdale Field Office .............................................................................. 360-396-6844 Supervisor of Shipbuilding (SUPSHIP) ..................................................................... 360-476-4326 Fleet and Industrial Supply Center (FISC) ................................................................ 360-476-4289 NAVSTA Bremerton, Contract Oversight (QAE).......................................................360-476-7947

BNC ENVIRONMENTAL POINTS OF CONTACT (For Contracting Officer Use):

PROGRAM SHIPYARD NAVSTA BREMERTON

Air (Permits/Discharges/ODS)* 360-476-0124 Asbestos 360-476-4699 360-476-4744 Contracts Support 360-476-0136 360-476-6691 Hazardous Material* 360-476-4364 Hazardous Waste (HW) 360-476-5734 360-476-6067 Historical/Natural Resources 360-476-4049 360-476-6691 Installation Restoration 360-476-2630 360-476-6691 PCBs 360-476-0127 360-476-6067 Solid Waste* 360-476-6067 Spill Prevention and Response* 360-476-1842 Water Quality and Stormwater/Sewer Discharge 360-476-0118 360-476-6614 *Program is managed for all of the BNC by the activity whose phone number is listed.

BNC ENVIRONMENTAL SERVICES (For Contracting Officer Use):

Waste Designation** ...............................................................................................................360-476-8612 HW/PCB (Containers/Labels/Turn-In (B-367)**.................................................................... 360-476-7777 **Services provided for all of the BNC.

ii

TABLE OF CONTENTS

Contractor’s Guide to

Environmental Compliance

INTRODUCTION ................................................................................................................ Page 1

WHAT IS ENVIRONMENTAL COMPLIANCE

AND WHY IS IT IMPORTANT? ............................................................................ Page 2

WHAT IS HAZARDOUS MATERIAL CONTROL

AND HOW DO I COMPLY? ................................................................................... Page 3

WHAT MATERIALS AND PRACTICES ARE PROHIBITED? ....................................... Page 5

WHAT IS STORMWATER AND WASTEWATER MANAGEMENT

AND HOW DO I COMPLY? ....................................................................................Page 6

WHAT SHOULD I DO TO PREVENT SPILLS? ............................................................. Page 11

WHAT IS A SPILL

AND WHAT SHOULD I DO IF I HAVE A SPILL? ............................................ Page 13

WHAT IS AIR POLLUTION

AND HOW DO I CONTROL IT?........................................................................... Page 15

WHAT SHOULD I DO BEFORE I DEMOLISH

OR RENOVATE A BUILDING? ........................................................................... Page 17

WHAT DO I NEED TO KNOW ABOUT ASBESTOS? .................................................. Page 18

WHAT DO I NEED TO KNOW ABOUT HISTORICAL PROPERTIES? ...................... Page 19

WHAT DO I NEED TO KNOW ABOUT EXCAVATIONS? .......................................... Page 20

I ACTUALLY HAVE TO “PLAN” FOR ALL OF MY WASTE? .................................... Page 23

HOW DO I MANAGE SOLID WASTE? .......................................................................... Page 24

WHAT IS HAZARDOUS WASTE

AND HOW DO I KNOW IF I HAVE ANY? ........................................................ Page 25

WHAT DO I NEED TO KNOW ABOUT PCB? ............................................................... Page 27 iii

INTRODUCTION

U.S. NAVY

The Chief of Naval Operations (CNO) has defined the Navy’s environmental vision to be “a Navy recognized as an environmental leader while effectively executing Naval operations.” The Navy is committed to operating in a manner compatible with the environment. National defense and environmental protection are, and must be, compatible goals. An important part of the Bremerton naval complex’s (BNC) mission is to prevent pollution and protect the environment. To fulfill this vision and mission, you (as a Navy-employed contractor) must provide the personal commitment to develop an environmental protection ethic.

Environmental regulations have increased exponentially in recent years. The BNC now operates under separate discharge permits for air emissions, dry docks, sanitary sewer, and storm water systems. Specific to hazardous waste, the BNC operates as a fully-regulated, large quantity generator. The BNC has implemented more stringent requirements than mandated by regulations in the area of accumulation for waste management. Compliance with environmental regulations and BNC rules requires specialized knowledge or expertise. In addition to this guide, you may request information regarding your environmental compliance responsibilities from the Contracting Officer, who will work in conjunction with BNC's environmental staff to assist you. Compliance with all applicable Federal, State, local, and BNC environmental requirements is mandatory.

WHAT IS ENVIRONMENTAL COMPLIANCE

AND WHY IS IT IMPORTANT?

Environmental Compliance

COMPLIANCE

“Environmental Compliance” is conformance to the many environmental regulations and BNC requirements. These regulations and requirements can vary with the different regulated media (e.g., air, water, waste) depending on your project status. For example, your project could be in compliance with water quality regulations but out of compliance with hazardous waste regulations.

WHY COMPLIANCE IS IMPORTANT

While your project may extend across several individual aspects of the BNC’s and Navy’s mission, there is one area that is impacted by virtually every one of your actions and operations: the environment. The Secretary of the Navy’s policy emphasized that “the Navy is fully committed to strict compliance with all applicable requirements.” In order for you to comply, you must have a solid understanding of the local, State and Federal regulations and the procedures set forth in the BNC’s Environmental Program, which should be included in your contract specifications, to comply with the regulations.

Environmental compliance, although it may be more costly initially, is a responsibility you must plan for and accept as a cost of doing business with the BNC and the Navy. Non-compliance is far more costly in the long run, not only in dollars, but in bad publicity which can affect future jobs and relations in the community. It may also affect your ability to perform future work for the Navy.

Proper environmental coordination with operations at the BNC, or any of the BNC-owned properties, is not only needed for compliance reasons, it also benefits your project by preventing time delays or operational shutdowns, and improves public relations. To this end, you must take a proactive approach to your policies, procedures, and operations.

WHAT IS HAZARDOUS MATERIAL CONTROL

AND HOW DO I COMPLY?

Hazardous Material

OSHA

HAZCOM

HAZARDOUS MATERIAL CONTROL

“Hazardous Material” is defined as any material, which because of its quantity, concentration, or physical, chemical, or infectious characteristics, may pose a substantial hazard to human health or the environment.

The Occupational Safety and Health Administration (OSHA), Hazard Communication (HAZCOM) standard, states that employees have the “Right-to-Know” about hazardous materials in their workplace. In addition, Congress has passed laws designed to help communities deal safely and effectively with hazardous materials that are used throughout our society. This law is called the Emergency Planning and Community Right-to-Know Act (EPCRA).

The procurement, storage, use, and minimization of hazardous material in the BNC requires control measures to protect the user, general public, and environment from potential or actual hazards. All hazardous materials must be approved by the Government prior to being brought to the BNC.

COMPLIANCE

To comply with these requirements, contractors and visitors shall ensure their employees working at the BNC are apprised of the requirements of the HAZCOM standard and EPCRA. Contractors shall provide a Hazardous Material Plan* to the Contracting Officer for review and approval prior to the start of any work requiring the use of hazardous materials. The Plan shall include the information listed on the next page:

* Depending on the type of contract, the information identified in this guide may be specified as a submission of the material inventory or be a subset of the Accident Prevention Plan. The submission and approval of the material inventory is required to comply with regulations implementing OSHA, EPCRA, and the Clean Air Act (CAA). Contact your Contracting Officer for the Contractor Hazardous Material Inventory form (PSNS 5090/132).

WHAT IS HAZARDOUS MATERIAL CONTROL

AND HOW DO I COMPLY?

(continued)

♦ An inventory of hazardous materials to be used at the work site. The inventory includes information identifying the material, manufacturer, and describing material storage requirements and usage. The inventory shall be updated at completion of the project specifying the quantities used. If your project goes into the next calendar year, then the quantity of material used through 31 December needs to be submitted in mid-January, and at the end of the project for material used since 1 January.

♦ Procedures for protecting personnel and property during the transport, storage, and use of the materials.

♦ Material Safety Data Sheets (MSDSs) for materials listed in the inventory. Material Safety

Data Sheets must be current and available at the work site where the materials will be used.

♦ Labeling system to identify contents of all containers on-site. Labeling system must be in accordance with the HAZCOM standard and includes the chemical name, manufacturer’s name and address, and chemical hazards.

♦ Procedures for training personnel in accordance with the HAZCOM standard.

CONTRACTOR HAZARDOUS MATERIAL INVENTORY 1

CONTRACTOR P.O.C. PHONE FAX DATE

W ORKPLACE/BUILDING CONTRACT NUMBER DELIVERY ORDER

CONTRACT OFFICE CONTRACTING OFFICER SIGNATURE PHONE FAX DATE

ADDITIONAL COMMENTS:

FOOTNOTES:

1. This form is used for initial approval of hazardous materials and to report subsequent usage. 6. Report actual quantities used at the end of the project; if the project goes beyond the

Use a separate inventory sheet for marine coatings. Include all materials, which contain an EHS, calendar year, report previous calendar year usage by 15 January. Report calendar month a CERCLA hazardous substance, a toxic chem ical, and/or require a Material Safety Data Sheet. usage for marine coatings no later than 5 calendar days after the end of each month.

2. Attach copy of MSDS. If an MSDS number is available Shop 90HM will complete this field. 7. See Table 2 – Process Types for appropriate codes.

3. Indicate physical form of the material (Solid, L iquid, Gas, M ixture). 8. Use the Remarks/Notes section to indicate specific information pertaining to the product

4. See Table 1 -- Storage Types for appropriate codes. (e.g., weight of each component for kits, mix ratios, etc.).

5 Include maximum amount present at any one time at a worksite. Maximum amount should The Government will also use this section to indicate items approved or disapproved.

occur when storage and floor stock is at a maximum.

PSNS 5090/132 (Rev. 7-99) (Front)

NAME SHOP 90 HM TECH SIGNATURE SHOP 90HM TECH PHONE FAX DATE

Product…