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Mate or uanrornia — u8norrna tnvironmentai Agency Department of Toxics Substances Control 8 . ) In an attached document , describe in detail your ability to properly remove and manage all materials that require special handling ( MRSH ) ( HSC 25211 A (a)) , found in appliances . The list below describes the level of detail that DISC would like to see: • General Knowledge- What types of MRSH are found in specific appliances? • Training- Who will provide training to personnel responsible for removing MRSH from appliances at your facility ? What are the contents of the training and what MRSH will be covered ? How frequently will staff be trained ? When will new staff be trained ? What hard copy and electronic training and reference materials will be made available to staff? • Health and Safety= Describe your facility' s health and safety plan and/or the duties of a safety officer. What personal protective equipment is used during the removal of MRSH ? Provide information for spill kits available at your facility . • Proposed removal processes- List the tools and equipment you use to remove each type MRSH . Briefly describe how each MRSH is identified and the procedure used to remove each type of MRSH from the appliance. • Storage9 - How long do you plan to accumulate removed MRSH at your facility ? Describe the containment of the MRSH . How are the containers labeled for each MRSH ? Describe how materials will be packaged to avoid breakage . Describe your record - keeping system . • Disposition of Waste - What will be the disposition of each MRSH ? Please provide the name of the company that picks up waste , or a description of where the waste is sent and/or how it gets there . What else should we know In order determine that you are capable of properly removing & managing MRSH? Optional : Site Information : Days and hours of operation of the facility: I f 1 1 7 . 3 0 - y - OD Open to the public? EJ Yes ❑ No Type, expected source , expected number or weight of appliances to be handled per month at your facility: ('na � ort v al- %Ipl % aArec arr kaAdttct ca . 1- r . l , Vs Sola t�vQC}J Facilt , esyo La 300 v / IV 1 II CL kkanCc' S qtr Mahe o, rCLXo .cdItA aT oir lorc ) Jn at 1VXCk . 8Lc f. L16\ erS dry, ? i5 CERTIFICATION ` ' 4e5 ) re (7r � ger-agar s 0. % m Jr [ terS & ^ d jo. e , lw�ea { er s CERTIFICATION I certify under penalty of perjury that this document and all attachments were prepared under my direction or supervision to assure that qualified personnel properly gathered and evaluated the information submitted . Based on my inquiry of the person or persons directly responsible for gathering the information , the information submitted is , to the best of my knowledge and belief, true , accurate and complete . Signature : Date : Printed Name : -3mn . ct DCdf r+. Cu te Title : ' Any MRSH that is a hazardous waste must be managed in accordance with Ch . 12 of 22 CCR DTSC 1428 ( 11 /04/2010) Daae 2 of 9