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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_facildsenior manager can sign this document. <br /> iT,� Hwz)c�, 110- I ("We"enter recipient name)hereby acknowledge receipt <br /> of the following product(s)with the full understandinof 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 remai ning <br /> materia!s(s)in accordance with applicable regulations.Upon taking possession of these product(s)we agree tofuIIy <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: 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 '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. Keep a copy for your records and a copy for the recipient. <br /> i; HAZARDOiJS MATERIAL OR LIMITED QUANTITY ITEL QUANTITY&TYPE OF CONTAINER <br /> =_ j Z TYPE OF <br /> .... _ <br /> o <br /> o a IF CONTAINER <br /> z z <br /> p, z AMOUNT Rnn, i.u.t.dr,eui. <br /> w �. c a DESCRIPTION i #OF ITEMS (gal, )=,lh,rlc.) pail,elc.) <br /> W <br /> a1 CA <br /> ¢= O <br /> IV <br /> - - �—_� <br /> a _ <br /> Vi <br /> i <br /> �,...� 7i <br /> AMMUNITION NOTE: Only facilities in AK& Hl 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 /> TFit C 121' U C'C . <br /> Facility Alpha Code/Number , cl ntAddress <br /> 01 <br /> FedEx Ground Facility for nagerPrinted Name Recipie nted ame <br /> i <br /> Fed <br /> Ground ity mor nagerSignature Reicipient Signature <br /> 9 _ <br /> `0 en- <br /> . Date Date <br /> Reference: Waste Minimization Plan, ENV-702 <br />