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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 all 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 /> • 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 removal 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 /> • Storage'-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 of properly removing&managing MRSH? <br /> Optional: Site Information: <br /> Days and hours of operation of the facility: M 4 Flim �— <br /> Open to the public? D---Yes ❑ No <br /> Type, expected source, expected number or weight of appliances to be handled per month at your facility: <br /> �aeU���UnrTs <br /> fiARco7c%)5 • 0b ' <br /> SIC 33 Z,��S�cJt : 87 f e� <br /> CERTIFICATION <br /> CERTIFICATION <br /> I certlfy�under pen lty;of perjury that this,document and all attachments .were prepared under <br /> my direction or'sup�rvislon�to assure that qualified.pemonnel proped 'igidthered.and evaluated <br /> the infarmationaubrrYftted.'Base&on my inquiry of the person.or.persons directly responsible <br /> _. <br /> for gathering-the°information;;the information submitted is, to the'best of rriy knowledge and <br /> ah <br /> Signature: ! <a,= �'—�- Date: <br /> r L}s <br /> Printed Name: jl�Cts ZEI l�' Title: (AUf r`,l <br /> RECEIVEC) <br /> ' Any MRSH that is a hazardous waste must be managed in accordance with Ch. 12 of 22 CCR JAN 2 6 2015 <br /> DTSC 1428(11/04!2010) EMPAMENTAL. <br /> 7C. �C�IT <br />