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❑Your Proposed Activities- What kinds of major appliances do you expect to recycle? What types of MRSH do you expect these appliances to contain? 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- Does your facility have a health and safety plan and/or a safety officer? What personal protective equipment used during the removal of MRSH? Are any spill kits available? Proposed removal processes- What tools and equipment will 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. Storage,- How long do you plan to accumulate removed MRSH at your facility? Describe the container for, and secondary containment of, the MRSH. How will you label the containers 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? Name of the company that picks up waste, or 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 Monday through Friday 7:30 am — 4:00 pm Open to the public? XYes No Type, expected source, expected number or weight of appliances to be handled per month at your facility: Very few appliances are handled at our facility each month, primarily we handle material out our clients solid waste facilities. Our facility may handle 10 appliances per month, varying in type, but could include washers, dryers, stoves, refrigerators, air conditioners, freezers, microwaves, trash compactors, space heaters, furnaces, and water heaters CERTIFICATION 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. Any MRSH that is a hazardous waste must be managed in accordance with Ch. 12 of 22 CCR Signature: 1 Date: June 8, 2009 Printed name: Title: Janice K. Oldemeyer President