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- N N <br /> State of Califomia-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: M47 E%a <br /> Open to the public? [-Yes ❑ No <br /> Type, expected source,expected number or weight of appliances to be handled per month at your facility: <br /> 6 - tLY11 (_U54�1-VA5 J (2jFL �l4,.etklC 11t�i1Y { 7P� r� UA l}- <br /> ��/tQ71�i15 ` 3G1�f 11(C 33 ' L� hE.` 7 ' (�1 VES �q; SE' S` 1}11C'r"Q tf�PUP. <br /> CERTIFICATION <br /> d " CER1IFlC T ONS <br /> certify nder peg per. tha is pct m nVan dZall attachmetts e e prepared, ra e <br /> m` dlrectlo dr�suP r tslo t ssetr hat qua ified personnel ro erre and evaluate <br /> xahe>Informa on bn t Ba ed�on m 'in ui of tl e` ecson:or ersons dlr c o sible. <br /> K;,or gatth�ering he ICt o atlon, ;h nformatlon submitted I�s,�to the best o't my�knowledge and# <br /> bellef,�ttrt�e; <br /> Signature: z- Date: <br /> Printed Name: �� l Title: e' rA 'f(771 < cou u'll�-k�L_ <br /> ' Any MRSH that is a hazardous waste must be managed in accordance with Ch. 12 of 22 CCR <br /> DTSC 1428(11104/2010) page 2 of 2 <br />