(DRAFT) TE-H - Hazardous_Material_Authorization (DRAFT).pdf
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- Solicitation number
- W91151-26-R-A004
About this file
This Technical Exhibit H is a Hazardous Material Authorization Request form used to track and authorize the use of potentially dangerous materials. The document provides detailed instructions for contractors to request approval for hazardous materials, requiring comprehensive information about the specific material, including its nomenclature, stock number, quantity, monthly requirements, container type, source of supply, manufacturer details, and precise description of the work process where the material will be used.
The form emphasizes the importance of providing specific, detailed information to expedite the approval process, with guidance on how to complete each section thoroughly. Contractors are encouraged to purchase hazardous materials from the HazMart, and for short-term contractors using non-government furnished hazardous materials, they must submit this form along with a Material Safety Data Sheet (MSDS) to Fort Hood for tracking purposes. The document includes a block-by-block breakdown of required information, ensuring that reviewers can fully understand the context and application of the requested hazardous material.
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TECHNICAL EXHIBIT H
Hazardous Material Authorization Request
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:
REMARKS
(Alternate material available?)
(name)
14. LIST BUILDING OR AREA WHERE THIS
MATERIAL WILL BE USED
15. COST CENTER/DODAC
AUTHORIZED TO USE THIS
MATERIAL
17. TECHNICAL REFERENCE REQUIRING
SPECIFIC USE
19. TECHNICAL POC AND PHONE
NUMBER
18. REQUESTER NAME AND PHONE
NUMBER
20. ORGANIZATION 21. DATE REQUESTED
TECHNICAL EXHIBIT H- 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)
7. UNIT OF MEASURE (must be weight or volume)6. UNIT OF ISSUE (EA, GL, CAN, etc.)
9. TYPE CONTAINER
(CAN, BOTTLE, TUBE, PLASTIC, METAL, GLASS, AEROSOL, etc.)
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)
D. INTO THE TRASH DUMPSTER
12. DESCRIBE THE WORK OR PROCESS IN WHICH THE MATERIAL WILL BE USED
A. ON THE END ITEM, EQUIPMENT, OR
PRODUCT
B. INTO THE AIR
C. INTO A WASTE DRUM
16. PROCESS
(Circle or check (x) one)
E. CENTRAL WASTE TREATMENT OR SEWER
F. OTHER
DPW-ENVIRONMENTAL USE ONLY
13. ESTIMATE WHAT PERCENTAGE OF THE PRODUCT ENDS UP IN THE
LISTED LOCATIONS
TE H - Hazardous Material Authorization Request 1
TECHNICAL EXHIBIT H
Hazardous Material Authorization Request
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.
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
12 Work or process description
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 t o 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.
TE H - Hazardous Material Authorization 2 of 2
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