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I i <br /> I <br /> OP-978 <br /> FedEx Ground 0112212021 <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 /> g ,`rt ("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 thatthe 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 containers) of remaining <br /> materials(s)in accordance with applicable regulations.Upon taking possession of these product(s)we agree to fully <br /> release and indemn'y 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: 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 OVERGOODS <br /> INSTRUCTIONS: Place an Yin 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. Keep a copy for your records and a copy for the recipient. <br /> HAZARDOUS MATERIAL OR LIMITED QUANTrrY ITEM QUANTITY&TYPE OF CONTAINER <br /> I LU <br /> TYPE OF <br /> CONTAIN <br /> z <br /> ¢. Di o� _ Uj AMOUNT (can, brae, in <br /> U' �c w DESCRIPTION #OF ITEMS (gal,oz,lb,etc.) pail,:arc.) <br /> 27111 . <br /> f <br /> — d1o� e o"Z <br /> AMMUNITION NOTE: Only facilities in AK&HI are to donate ammunition to authorized enforcement agencies. AiI 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 /> 7-ajq (� 1 -:�Sl -5 <br /> Facility Alpha Code/Number Rec enlAddross <br /> �5`ef1fe�- kt <br /> FedEar�n Facility Senior Man ted Name Re ' 'entPriinted^Name <br /> r7T <br /> FedEXGroun acilitySenior Mana signature IjRedpienl&gnature <br /> 07 -22 - 2-1 -.-;2 3- <br /> Date Date <br /> Reference: Waste Minimization Plan,ENV-702 <br />