Laserfiche WebLink
OP-978 <br /> FedEx Ground 01i22izo21 <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: Ont the faJci!rty senior manager can sign this document. <br /> ("We"enter recipient name)hereby acknowledge receipt <br /> of the following product's)with the full unde.,standino their origin(i.e.,part of a damaged package s hipment), We <br /> have been advised lhatthe materials)constitute hazardous substances under federal and state laws and must be <br /> used in accordance with its intended use end purpose. We will properly d Is pose of emptycontalner(s) or remaining <br /> materials(s)it accordance with applicable regulations Upon taking possession of these products)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 /> Products) received: <br /> IMPORTANT: An eligible donation or reuse distribution is items that have been evaluated as either a hazardous material or Limited <br /> Quantity, Items not evaluated as a hazardous material or Limited Quantity must be sent to O VERGOODS. <br /> INSTRUCTIONS: Place an 'X'in the category and include a description for each container donated for reuse distribution. Be sure to <br /> vrindicate whether the item(s)is/are hazardous material or Limited Quantity. Keep a copy for your records and a copy for the recipient. <br /> L <br /> HAZARDOUS MATERIAL OR LIMITED QUANTITY ITEM i. QUANTITY 8r TYPE OF CONTAINER <br /> TYPE OF <br /> = o a II CONTAINER <br /> Z <br /> a o ZI w4 AMOUNT I(can.box.dnnrr,i <br /> w DESCRIPTION #OF ITEMS (gal,oz.!h.etc) pail,etc) <br /> 4LOIL__ <br /> r S&r-_ J — <br /> - ---- <br /> � h <br /> I� <br /> eZ — <br /> I <br /> L <br /> AMMUNITION NOTE- Only faciMies in AK. &NI 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 /> recipients identifica``tiio�on (i.e. badge, license, etc.)to this form and retain arcopyy for your records. <br /> Facility Alpha Code/Number Recipient Address <br /> FedEx nd Facili Sento nage anted Name —RecipriV ci ient ted 'ame <br /> FedEx Ground FFj cilily Sen iorManag <br /> e Signature Recipient Signature <br /> Date Dale <br /> Reference: Waste Minimization plan, ENV-702 <br />