Laserfiche WebLink
OP-978 <br /> FedEx Ground 050/2020 <br /> Hazardous Material Donation and Reuse Distribution <br /> Acknowledgment of Receipt <br /> If you need assistance in filling out this form,please contact the Environmental Affairs department. <br /> Note: Only the facility senior manager can sign this document. <br /> -1C(-Y14 5�tiL—CA ("We" enter recipient name) hereby acknowledge receipt <br /> of the following product(s) with the full understAnding of their origin (i.e., part of a damaged package shipment). We <br /> have been advised that the material(s) constitute hazardous substances under federal and state laws and must be <br /> used in accordance with its intended use end purpose. We will properly dispose of empty container(s) or remaining <br /> materials(s) in accordance with applicable regulations. Upon taking possession of these product(s) we agree to fully <br /> release and indemnify FedEx Ground Package System, Inc. ("FedEx Ground") from any liability arising from the use of <br /> these materials(s) excluding tax liability. <br /> Product(s) received: <br /> IMPORTANT: Aa eligible donation or reuse distribution is items that have been evaluated as either a hazardous material or Limited <br /> Ouantity/ORM-D. Items not evaluated as a hazardous material or Limited Quantify/ORM-D must be sent to OVERGOODS. <br /> INSTRUCTIONS: Place an 'X'in the category and include a description for each container donated for reuse distribution. Be sure to <br /> indicate whether the item(s) is/are hazardous material or Limited Quantity/ORM-D. Keep a copy for your records and a copy for the <br /> recipient. <br /> HAZARDOUS MATERIAL OR LIMITED QUANTITYIORM-D ITEM QUANTITY & TYPE OF CONTAINER <br /> z TYPE OF <br /> X O CONTAINER <br /> Zi Oj CC AMOUNT (carr•h—,drum, <br /> o� a s DESCRIPTION #OF ITEMS (gal,oz,1b,etc.) Poil,e1c) <br /> -iI a d a o <br /> 'et SO <br /> ___.. ._ . <br /> A <br /> AMMUNITION NOTE: Only facilities in AK 8 Hi are to donate ammunition to authorized enforcement agencies.All other facilities <br /> must send their ammunition to Overgoods. If you are one of the facilities that are authorized to donate,attach a copy of the <br /> recipient's identification(i.e. badge,license, etc.)to this form and retain a copy for your records. <br /> Facility Alpha Code/dumber Recipient Address <br /> �c�zcilmai <br /> FedEx Gr Fa ity Senior Hager nted Name Recipient Printed Name <br /> r <br /> FedEx Groun a ility Sen/or Manager ignature Recipient Signature <br /> 3- 7j <br /> ate Date <br /> Reference; Waste Minimization Plan, ENV-702 <br /> �J <br />