Draft TE E-Hazardous Material Request.pdf
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- Attached to
- Kitchen Hood Services Federal contract opportunity
- Solicitation number
- W91151-20-R-0003
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Text version
COMPANY
NAME
COMPANY
NAME
ADDRESS ADDRESS
PHONE/FAX PHONE/FAX
NEW
CURRENT
(phone) (name) (phone)
AUTHORIZATION
CONTROL
NUMBER
MSDS
SERIAL
NUMBER
NFPA 704 LABEL
DATA
HEALTH: FLAMMABILITY: REACTIVITY: SPECIAL INSTRUCTIONS:
E. CENTRAL WASTE TREATMENT OR SEWER
A. ON THE END ITEM, EQUIPMENT, OR
PRODUCT
13. ESTIMATE WHAT PERCENTAGE OF THE PRODUCT ENDS UP IN THE
LISTED LOCATIONS
14. LIST BUILDING OR AREA WHERE THIS
MATERIAL WILL BE USED
15. COST CENTER/DODAC
AUTHORIZED TO USE THIS
MATERIAL
DPW-ENVIRONMENTAL USE ONLY
21. DATE REQUESTED19. TECHNICAL POC AND PHONE
NUMBER
(name)
C. INTO A WASTE DRUM
18. REQUESTER NAME AND PHONE
NUMBER
20. ORGANIZATION
B. INTO THE AIR
9. TYPE CONTAINER
(CAN, BOTTLE, TUBE, PLASTIC, METAL, GLASS, AEROSOL, etc.)
5. MONTHLY REQUIREMENT
(estimate monthly usage or a one-time purchase)
8. UNIT OF USE (must be weight or volume, e.g., pounds, gallons, etc.)
10. SUGGESTED SOURCE OF SUPPLY 11. MANUFACTURE INFORMATION
(complete if different than supplier)
F. OTHER
TECHNICAL EXHIBIT-E HAZARDOUS MATERIAL AUTHORIZATION REQUEST
REQUESTOR USE
1. NOMENCLATURE/TRADE NAME
2. STOCK NUMBER (NSN, LSN, MCN, etc.) 3. PART NUMBER
17. TECHNICAL REFERENCE REQUIRING
SPECIFIC USE
16. PROCESS
(Circle or check (x) one)
4. QUANTITY REQUESTED
7. UNIT OF MEASURE (must be weight or volume)6. UNIT OF ISSUE (EA, GL, CAN, etc.)
D. INTO THE TRASH DUMPSTER
12. DESCRIBE THE WORK OR PROCESS IN WHICH THE MATERIAL WILL BE USED
REMARKS
(Alternate material available?)
HazMat Request
File details come from the government source that posted it. Updated .