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HEALTH AND SAFETY EVALUATION—CHEMICAL HAZARDS OF CONCERN-FORM 4(REVISED 02/1998) ❑ N/A ❑ N/A Chemical Contaminants of Concern Identify hazardous materials used or on-site and attach Material Safety Data Sheets Provide the data requested for chemical contaminants on HASP Form 25 or attach data (MSDSs)for all reagent type chemicals,solutions,or other identified materials that in sheets from an acceptable source such as NIOSH pocket guide,condensed chemical normal use in performing tasks related to this project could produce hazardous dictionary,ACGIH TLV booklet,etc. List chemicals and concentrations below and substances. Ensure that all subcontractors and other parties working nearby are locate data sheets in Attachment B of this HASP. informed of the presence of these chemicals and the location of the MSDSs. Obtain from subcontractors and other parties, lists of the hazardous materials they use or have on-site and identify location of the MSDSs here. List chemicals and quantities below and locate MSDSs in Attachment B of this HASP. Chemical Name Concentration Chemical Name Quantity if known total petroleum hydrocarbons(TPH)-diesel,TPH-gasoline Unknown Alconox 4 ounces and TPH-motor oil volatile organic compounds(VOCs) Unknown polycyclic aromatic hydrocarbons(PAHs) Unknown metals(particularly lead) Unknown OSHA-SPECIFIC HAZARDOUS SUBSTANCES The following substances may require specific medical,training,or monitoring based on concentration or evaluation of risk.See the appropriate citation listed under 29 CFR 1910 or 1926 for additional information. ❑ 19 10.1001 Asbestos ❑1910.1002 Coal tar pitch volatiles ❑ 1910.1003 4-Nitrobiphenyl,etc. ❑1910.1004 alpha-Naphthylamine ❑ 1910.1005[Reserved] ❑1910.1006 Methyl chloromethyl ether ❑ 1910.1007 3,3'-Dichlorobenzidine(and its salts) ❑1910.1008 bis-Chloromethyl ether ❑ 1910.1009 beta-Naphthylamine ❑19 10.10 10 Benzidine ❑ 1910.1011 4-Aminodiphenyl ❑1910.1012 Ethyleneimine ❑ 1910.1013 beta-Propiolactone ❑1910.1014 2-Acetylaminofluorene ❑ 1910.1015 4-Dimethylaminoazobenzene ❑1910.1016 N-Nitrosodimethylamine ❑ 1910.1017 Vinyl chloride ❑1910.1018 Inorganic arsenic ® 1910.1025 Lead(Att.FLD#46) ❑1910.1027 Cadmium ® 1910.1028 Benzene ❑1910.1029 Coke oven emissions ❑ 1910.1043 Cotton dust ❑1910.1044 1,2-Dibromo-3-chloropropane ❑ 1910.1045 Acrylonitrile ❑1910.1047 Ethylene oxide ❑ 1910.1048 Formaldehyde ❑1910.1050 Methylenedianiline ❑1910.1051 1,3 Butadiene ❑1910.1052 Methylene chloride 5 of 23