A01_FTCKY_Hazmat_Inventory_Form.pdf

FTCKY Hazmat Inventory Form

The contractor must complete and submit the FTCKY HAZMAT INVENTORY FORM, to include type and quantity of hazardous materials (HM) to be brought to the post and corresponding material safety data sheets (MSDS), prior to beginning action.

All HM requirements are found in the Fort Campbell Installation Technical Design Guide: See pp. 44-45, 63. As required by the Emergency Planning and Community Right-to-Know Act (EPCRA), the contractor will develop a site specific Environmental Protection Plan, in which "the Contractor will account for the quantity of HM brought to the post, the quantity used or expended during the job, and the leftover quantity which (1) may have additional useful life as HM and shall be removed by the Contractor, or (2) may be hazardous waste" (HW), which shall be removed per Fort Campbell requirements and disposed of offsite according to applicable regulations at the contractor's expense. The contractor shall submit an annual report on the use of HM and generation of HW on post to the Contracting Officer. Per 49 CFR 171-177, all HM transported to Fort Campbell must be properly containerized and labeled.

Work Order/Project No.

Project Hazardous Materials Log (print)

Activity: Contractor: Contract #: Date:

Bldg. #: POC: COR: COR Phone #:

Date

Product Name

Product Manufacturer

FSN/NSN/Product No.

Estimated # of Containers to be

Used

Actual # of

Containers Used

Container Size

(volume)

MSDS Attached?

HMINVTRY.0

Revised:

March 2015

FTCKY Hazmat Inventory Form