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Project Task: <br /> Name of Preparer: <br /> Describe Evaluation of Alternatives to Chemical Use: <br /> Chemicals to be Used for Project: <br /> Chemical Name Quantity (indicate units) <br /> Names of Staff Using Chemicals During Project: <br /> Describe Personal Protection to be Used When Using or Handling Chemicals: <br /> ❑ Safety Goggles ❑ Portable Eye Wash <br /> ❑ Nitrile Gloves ❑ Splash Apron/Coveralls <br /> ❑ Respirator with cartridges ❑ Face Shield <br /> ❑ Other: <br /> Describe how Chemicals will be Transported and Stored at Project Site: <br /> Describe How Used or Leftover Chemicals will be Disposed: <br /> Business Unit Health and Safety Manger Approval Signature Date Approved <br />