TECHNICAL_EXHIBIT_AA_HAZARDOUS_MATERIAL_AUTHORIZATION_REQUEST.xlsm
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- Fire Protection Services, Fort Hood, TX
- Solicitation number
- W91151-16-R-0013
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TECHNICAL EXHIBIT AA HAZARDOUS MATERIAL AUTHORIZATION REQUEST
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HazMat Request
| TECHNICAL EXHIBIT AA - 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:
TE-F-1 Form 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 |
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