USEB152003 - 5c. Hazardous Material Identification Form.pdf
PDF 314 KB Posted
- Attached to
- Demolish Salty Guard Bldg. 1522
- Solicitation number
- W50S9A25QA011
About this file
The document is a Hazardous Material Identification Form for a federal construction project (Project Name: "Fixing That Thing" - USEB0015) in Salt Lake City, Utah. The form requires detailed reporting of hazardous materials used during construction, including specific details like part numbers, material names, manufacturers, and actual amounts used. The example form shows three hazardous materials: Engine degreaser (3 x 13 oz. cans), Maskout Paint (2 x 13 oz. cans), and Rubber Silicone Sealant (1 x 2.8 FL. oz. Tube), all to be reported monthly. The form instructs contractors to provide a Safety Data Sheet for each new chemical and lists reportable materials such as strippers, acid wash, refrigerants, diesel fuel, oil-based paints, concrete sealer, herbicides, and gasoline.
View the file
Other files
Show all 13
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
SALT LAKE CITY - UT Hazardous Material Identification Form
Reporting on Hazardous Material Usage A hazardous material is “any item or agent (biological, chemical, physical) which has the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors.”
Therefore, materials that must be reported are:
ALL materials that will affect air emission reporting
ANY Materials whose intended use will generate hazardous waste ALL class I & II ozone depleting substances
Extremely Hazardous materials
Following are examples of materials that must be reported (this list is NOT all inclusive).
Strippers Acid wash Refrigerants Diesel fuel Oil based paints
Concrete sealer Herbicides Gasoline Polyurethane paint Roof Sealer
Asphalt (report in yrds) Stains Industrial adhesives
Reporting Instructions
Prior to start of construction
Complete the following sections:
Part Number – An alphanumeric code found on each product container used by the Hazmart Pharmacy to help locate an MSDS
Material Name – Brand name; be as specific as possible
Manufacturer Name
Amount – Report monthly; be sure to include units consistent with the units on the container
*Provide a Safety Data Sheet once for each new chemical.*
Report on Hazardous Material Usage Report Month__ June 2015 Project Name____ “Fixing That Thing ‐USEB0015” General Contractor __ AB Construction
Part Number Material Names Manufacturer Actual Amount Used (To be re‐ ported monthly)
6850012110986 Engine degreaser Engine bright 3 x 13 0z. cans
TAN S‐249 Maskout Paint Uline 2 x 13 0z. cans
0006451413 Rubber Silicone Sealant Dap 1 x 2.8 FL oz. Tube
Pre-construction Monthly
Example
*Provide a Safety Data Sheet once for each new chemical.*
Report Month: _______________
Project Name:_____________________________ Prime Contractor:__________________
Part Number Material Name Manufacturer Container Size Actual Amount Used
Pre-construction Monthly
| Report Month: |
| Project Name: |
| Prime Contractor: |
| Part NumberRow1: |
| Material NameRow1: |
| ManufacturerRow1: |
| Container SizeRow1: |
| Actual Amount UsedRow1: |
| Part NumberRow2: |
| Material NameRow2: |
| ManufacturerRow2: |
| Container SizeRow2: |
| Actual Amount UsedRow2: |
| Part NumberRow3: |
| Material NameRow3: |
| ManufacturerRow3: |
| Container SizeRow3: |
| Actual Amount UsedRow3: |
| Part NumberRow4: |
| Material NameRow4: |
| ManufacturerRow4: |
| Container SizeRow4: |
| Actual Amount UsedRow4: |
| Part NumberRow5: |
| Material NameRow5: |
| ManufacturerRow5: |
| Container SizeRow5: |
| Actual Amount UsedRow5: |
| Part NumberRow6: |
| Material NameRow6: |
| ManufacturerRow6: |
| Container SizeRow6: |
| Actual Amount UsedRow6: |
| Part NumberRow7: |
| Material NameRow7: |
| ManufacturerRow7: |
| Container SizeRow7: |
| Actual Amount UsedRow7: |
| Part NumberRow8: |
| Material NameRow8: |
| ManufacturerRow8: |
| Container SizeRow8: |
| Actual Amount UsedRow8: |
| Part NumberRow9: |
| Material NameRow9: |
| ManufacturerRow9: |
| Container SizeRow9: |
| Actual Amount UsedRow9: |
| Part NumberRow10: |
| Material NameRow10: |
| ManufacturerRow10: |
| Container SizeRow10: |
| Actual Amount UsedRow10: |
File details come from the government source that posted it. Updated .