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} <br /> State of California - California Environmental Agency Department of Toxics Substances Control <br /> 8 .) In an attached document, describe in detail your ability to properly remove and manage AU materials that require <br /> special handling (MRSH) (HSC 25211 .4 (a )), found In appliances . The list below describes the level of detail that <br /> DTSC would like to see: <br /> • General Knowledge-What types of MRSH are found in specific appliances? <br /> • <br /> Training* Who will provide training to personnel responsible for removing MRSH from appliances at your <br /> facility? What are the contents of the training and what MRSH will be covered? How frequently will staff be <br /> trained? When will new -staff be trained ? What hard copy and electronic training and reference materials will <br /> be made available to staff? <br /> Health and Safety- Describe your facility's health and safety plan and/or the duties of a safety officer. What <br /> personal protective equipment is used during the removal of MRSH ? Provide Information for spill kits <br /> available 'at your facility. <br /> • Proposed removai processes = List the tools and equipment you use to remove each type MRSH .. Briefly <br /> describe how each MRSH is identified and the procedure used to remove each type of MRSH from the <br /> appliance. <br /> Storages- How long do you plan to accumulate removed MRSH at your facility? Describe the containment of <br /> the MRSH. How are the containers labeled for each MRSH? Describe how materials will be packaged to <br /> avoid breakage. Describe your record-keeping system . <br /> Disposition of Waste- What will be the disposition of each MRSH? Please provide the name of the company <br /> that picks up waste, or a description of where the waste is sent and/or how it gets there. <br /> What else should we know in order determine that you are capable pf properly removing & managing MRSH? <br /> Optional : Site Information : <br /> Days and hours of operation of the facility: «1 ` � . m <br /> Open to the public? ales ❑ No <br /> Type, expected source , expected . number .or weight of appliances to be handled per month at your facility: <br /> Vn) \ Q 546nyia" 49: e )XL 1 k "Ymk C 0e, V J? ()Afi`5 i <br /> O!MIuAZ�;�^� Zc�iS ' 3Utn r TIC i 33 L Slwi ; 87 �DUer � ftYtp S ! ltlttrot� �rP ' <br /> _ . ,_ . . <br /> CERTIFICATION77 <br /> ` + + <br /> �ERTirFICATIO <br /> 3 .P 3 X,.7 Is <br /> i tcertlfy�t nd� r pert`alty a penury,that , thVdocument1. Landtall4, Y if , atti chmentsYwere prepared tender <br /> my direction or .stip rvlsfah ita, assurtr th itquallfletlapersannel properlyigaf1114 hered antl $valuated <br /> ti thetnfotmatio stbrri' ite`d gaseif tl "oil my Inquiry afsthe £personor,persons � trect�� ;respansibie , <br /> ;11�foi gathsrtng the infa 1dn the irfpratian su6mttto ts, 3ta tie best, ofirny knowle`c ge and - - <br /> i n6si -r <br /> bei��f,-trot accurateaad - ff <br /> cor��pleif ctfz <br /> tz <br /> Date # <br /> Signature : -- . <br /> -1 <br /> Printed Name : <br /> �foi n L C ` - . Title : ' Of <br /> Any _MRSH .that_Is a hazardous waste must be _managed in accordance with Ch . 12 of 22_CCR _ <br /> page 2 of 2 <br /> DTSC 1428 ( 11 /0412010) <br /> i <br />