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OP-978 FedEx Ground 11/16/2021 Hazardous Material Donation and Reuse Distribution Acknowledgment of Receipt If you need assistance in filling out this form, please contact the Environmental Affairs department. Note: Only the facilitysenior manager can sign this document. __________________________________________ ("We" enter recipient name) hereby acknowledge receipt of the following product(s) with the full understanding of their origin (i.e., part of a damaged package shipment). We have been advised that the material(s) constitute hazardous substances under federal and state laws and must be used in accordance with its intended use end purpose. We will properly dispose of empty container(s) or remaining materials(s) in accordance with applicable regulations. Upon taking possession of these product(s) we agree to fully release and indemnify FedEx Ground Package System, Inc.("FedEx Ground")from any liability arising from the use of these materials(s) excluding tax liability. Product(s)received: IMPORTANT. An eligible donation or reuse distribution is items that have been evaluated as either a hazardous material or Limited Quantity. Refer to QAL-300 for items not evaluated as a hazardous material or Limited Quantity. INSTRUCTIONS: Place an Xin the category and include a description for each container donated for reuse distribution. Be sure to indicate whether the item(s)is/are hazardous material or Limited Quantity. Keep a copy for your records and a copy for the recipient. HAZARDOUS MATERIAL OR LIMITED QUANTITY ITEM QUANTITY &TYPE OF CONTAINER > z O Z p Q TYPE OF Z p w AMOUNT CONTAINER in w 2 DESCRIPTION #OF ITEMS (gal,oz,Ib,etc) (can,box,drum, V Q a Q I oil 11 i 1 pail,etc.) � m AMMUNITION NOTE: Only facilities in AK&HI are to donate ammunition to authorized enforcement agencies. All other facilities must send their ammunition to Overgoods. If you are one of the facilities that are authorized to donate,attach a copy of the recipient's identification(i.e.,badge,license, etc.)to this form and retain a copy for your records. Facility Alpha Code/Number Recipient Address FedEx Ground Facility Senior Manager Printed Name Recipient Printed Name FedEx Ground Facility Senior Manager Signature Recipient Signature Date Date Reference:Waste Minimization Plan,ENV-702