Location Description: Location of the distribution point (e.g. behind the motor pool, building xx, etc) Container Size Preferred volume of container can be found on label. If volume cannot be determined, physical dimensions of container should be obtained Number of containers: describe the number of containers present. If there are different sized/type containers, describe the number of each size/type. Container Type: metal, plastic, single walled, double walled, etc. Container Age: Approximate age of container; can be on container label or from installer of container? Above / Below Ground: Is the container or will the container be placed above or below ground? 5a. Hazardous Materials - Petroleum Distribution Points Present: Absent: If Present, list below Are any existing or former fuel points? Container Contractor Fuel Type Location Description Above or Below Operated Size Number Type Age grd Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Do petroleum distribution sites have the potential to affect personnel? (Current, Past, Yes: No: If yes, complete the Exposure Pathway form Potential) located at the end of this template. 5a. Hazardous Materials - Petroleum Distribution Points (continued) Notes: General Notes related to POL distribution in general.
Location Description: Location of the distribution point (e.g. behind the motor pool, building xx, etc) Container Size Preferred volume of container can be found on label. If volume cannot be determined, physical dimensions of container should be obtained Number of containers: describe the number of containers present. If there are different sized/type containers, describe the number of each size/type. Container Type: metal, plastic, single walled, double walled, etc. Container Age: Approximate age of container; can be on container label or from installer of container? Above / Below Ground: Is the container or will the container be placed above or below ground? 5a. Hazardous Materials - Petroleum Distribution Points Are any existing or former fuel points? Present: Absent: If Present, list below Fuel Type Location Description Container Contractor Operated Size Number Type Age Above or Below grd Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Gas Diesel JP-4 JP-8 Abv Bel Yes No Do petroleum distribution sites have the potential to affect personnel? (Current, Past, Potential) Yes: No: If yes, complete the Exposure Pathway form located at the end of this template. 5a. Hazardous Materials - Petroleum Distribution Points (continued) Notes: General Notes related to POL distribution in general.
OEHSA_w_Instructions_2.0.15.0.docx