TEI.xls

XLS spreadsheet 41 KB Posted Oct 17, 2012

Attached to: Installation Custodial Services - Fort Hood, Texas
Solicitation number: W91151-12-R-0035
Issued by: Department of the Army Materiel Command Mission and Installation Contracting Command Fort Hood

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Technical Exhibit I Hazardous Material Authorization Request Form

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File	Type	Posted
Solicitation_W91151-12-R-0035_Amendment_0006.doc	DOC document	Oct 31, 2012
W91151-12-R-0035_Solicitation_Amendment_0005.doc	DOC document	Oct 26, 2012
Site_Visit_11_Oct_2012_Attendees_List.pdf	PDF	Oct 19, 2012
TE_M_ESTIMATED_EQUIPMENT_LIST.xls	XLS spreadsheet	Oct 19, 2012
TE_N_ESTIMATED_SUPPLY_LIST.xls	XLS spreadsheet	Oct 19, 2012
W9115112R0035Amendment0004.doc	DOC document	Oct 19, 2012
RevisedTED4Oct12.xls	XLS spreadsheet	Oct 17, 2012
Amendment0002W9115112R0035.doc	DOC document	Oct 17, 2012
TEO.pdf	PDF	Oct 17, 2012
TEE.doc	DOC document	Oct 17, 2012
TEN.xls	XLS spreadsheet	Oct 17, 2012
TED.xls	XLS spreadsheet	Oct 17, 2012
TEA.doc	DOC document	Oct 17, 2012
TEC.doc	DOC document	Oct 17, 2012
ATTACHMENT3.doc	DOC document	Oct 17, 2012
TEP.doc	DOC document	Oct 17, 2012
ATTACHMENT2.doc	DOC document	Oct 17, 2012
TEH.pdf	PDF	Oct 17, 2012
TEM.xls	XLS spreadsheet	Oct 17, 2012
TEK.xls	XLS spreadsheet	Oct 17, 2012
TEB.doc	DOC document	Oct 17, 2012
SolicitationW9115112R0035.doc	DOC document	Oct 17, 2012
ATTACHMENT1.doc	DOC document	Oct 17, 2012
TEJ.xls	XLS spreadsheet	Oct 17, 2012
TEF.pdf	PDF	Oct 17, 2012
RevisedTEL4Oct12.xls	XLS spreadsheet	Oct 17, 2012
W9115112R0035Amendment0001.doc	DOC document	Oct 17, 2012
Amendment0003W9115112R0035.doc	DOC document	Oct 17, 2012
TEG.pdf	PDF	Oct 17, 2012
TEL.xls	XLS spreadsheet	Oct 17, 2012

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HazMat Request

Technical Exhibit-"I" HAZARDOUS MATERIAL AUTHORIZATION REQUEST
REQUESTOR USE
1. NOMENCLATURE/TRADE NAME
2. STOCK NUMBER (NSN, LSN, MCN, etc.)	3. PART NUMBER
4. QUANTITY REQUESTED	5. MONTHLY REQUIREMENT

(estimate monthly usage or a one-time purchase)

6. UNIT OF ISSUE (EA, GL, CAN, etc.)	7. UNIT OF MEASURE (must be weight or volume)
8. UNIT OF USE (must be weight or volume, e.g., pounds, gallons, etc.)	9. TYPE CONTAINER

(CAN, BOTTLE, TUBE, PLASTIC, METAL, GLASS, AEROSOL, etc.)

10. SUGGESTED SOURCE OF SUPPLY 11. MANUFACTURE INFORMATION

(complete if different than supplier)

	COMPANY NAME					COMPANY NAME
	ADDRESS					ADDRESS
	PHONE/FAX					PHONE/FAX
	12. DESCRIBE THE WORK OR PROCESS IN WHICH THE MATERIAL WILL BE USED					13. ESTIMATE WHAT PERCENTAGE OF THE PRODUCT ENDS UP IN THE LISTED LOCATIONS
								%
						A. ON THE END ITEM, EQUIPMENT, OR PRODUCT
						B. INTO THE AIR
						C. INTO A WASTE DRUM
						D. INTO THE TRASH DUMPSTER
						E. CENTRAL WASTE TREATMENT OR SEWER
						F. OTHER
	14. LIST BUILDING OR AREA WHERE THIS MATERIAL WILL BE USED			15. COST CENTER/DODAC AUTHORIZED TO USE THIS MATERIAL		16. PROCESS
(Circle or check (x) one)		17. TECHNICAL REFERENCE REQUIRING SPECIFIC USE
						NEW
						CURRENT
	18. REQUESTER NAME AND PHONE NUMBER			19. TECHNICAL POC AND PHONE NUMBER		20. ORGANIZATION	21. DATE REQUESTED
	(name)		(phone)	(name)	(phone)
	DPW-ENVIRONMENTAL USE ONLY
	AUTHORIZATION CONTROL NUMBER		MSDS SERIAL NUMBER			REMARKS

(Alternate material available?)

NFPA 704 LABEL DATA HEALTH: FLAMMABILITY: REACTIVITY: SPECIAL INSTRUCTIONS:

&CTE-C-1&RForm Dated: October 2003

Instructions Information required for your Hazardous Material Authorization Request.

NOTE: Contractors are strongly encouraged to purchase hazardous materials at the HazMart. On those rare occasions that short-term contractors use non-government furnished HAZMAT, they must use the Hazardous Material Authorization Request to notify Fort Hood of HAZMAT usage and submit an MSDS for all materials. In these cases, MSDS are used for tracking purposes and does not imply endorsement of any product by Fort Hood.

Block	Description	Information Required
1	Nomenclature	If not a government source NSN, enter a descriptive noun for the item you are purchasing, i.e., SAE 30 oil, yellow spray paint, lead acid battery…
2	NSN	Enter NSN if item is from a government source of supply. If it is, skip to block 4.
3	Part Number	Enter as appropriate, using the most specific information available
4	Quantity Requested	Make every effort to enter only how much you will need to sustain your process for 7-10 days. The only exceptions should be for those items where the smallest size procurable (UI) lasts longer in your process. If a weekly or monthly interval does not work in your process, contact the HMCG to establish special tracking requirements.
5	Monthly Requirement	How much do you use per Month? Enter a quantity and select the appropriate unit: FL OZ, Gallon, Gram, KG, LB, Liter, OZ, Pint, Quart, Troy Oz. An example would be using 5 qts to change oil in car.
6	Unit of Issue	Unit of issue. Examples are ea, gal, qt, oz…
7	Unit of Measure	Enter the quantity of the size, and select the appropriate measuring unit: Fluid Oz, Gallon, Gram, KG, LB, Liter, Oz, Pint, Quart, Troy Oz.
8	Unit of Use	If decanting, what unit will you issue/use
9	Type Container	Select the appropriate container description. Bottle, Box, Can, Cartridge, Drum. If not listed, fill in the container type next to “other”
10	Suggested Source of Supply	Name of Brand Name or source of supply
11	Manufacturer Information	Enter the manufacturer information. This is very important to determine the correct MSDS and chemical formulation. You may also find this on the container.
12	Work or process description	A full description of the work activity and process in which the HAZMAT is used. More detail in this block enhances your chances of approval, i.e.,
		Application method, such as hand, brush, spray gun/nozzle, or vapor condensation
		Type of industrial equipment, such as open tanks, closed tanks, vapor degreaser, spray booth, mechanical equipment, or other system
		If the HAZMAT are transferred to industrial equipment, list the equipment number and specify whether the transfer will occur by pouring, pumping, or another method
		The process codes located in Section 8.6 may help to identify the use or application of the HAZMAT. List the process code that best describes the application or use for the HAZMAT.
		Method by which HAZMAT may be mixed or combined with other ingredients, such as hand, mixer, open container, closed container
		Explain what will happen to the HAZMAT in the process, such as heated in an oven, soldering iron, torch, or heated to facilitate parts washing, or even used to facilitate removal of other HAZMAT by wire brush, sander, grinder.
		The important thing here is to be as specific as possible, which can shave days off the approval process – use additional paper if necessary and remember your reviewers don’t do your work – explain it so they can understand it (some of them are not as smart as you).
13	Product Use	Make a best estimate (%) for each item
14	Where is the product used	Provide a building number or location
15	DODAC/Cost Center	Enter your DODAC for your unit/activity
16	Process	Circle the appropriate answer
17	Technical Reference	Where is the authorization to use this HAZMAT? I.E, TM,LO,Etc.
18	Requestor Name	Your name
19	Technical POC	Who can answer questions about the process using the HAZMAT
20	Organization	Where do you come from
21	Date Requested	Date HMAR form is completed

&L&F&RPage &P of &N

File details come from the government source that posted it. Updated Nov 14, 2017.