Name of Location:

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					  GM Global
Containerization                               Recycling Authorization and Confirmation Form
  Recycling                                     for Shipping Racks, Containers, and Dunnage
  1120 Form
      RETURN VIA EMAIL TO: MAURICE.DAVIS@GM.COM PICTURES MUST BE INCLUDED WITH FORM. SAVE AS A WORD DOCUMENT ONLY.

 Section 1 – to be completed by Requesting Location. All fields are required. Address must be for physical
 location of containers to be scrapped.
  Name of Requesting Location:                                                        Date:
                  Street address:                                                    Duns #:
   City, State/Prov, Postal Code:                                                       Fax:
       Contact to view material:                                                     Phone:
                   Email address:                                                      Cell:
         Loading days and times:
    GM Program Name
     Production Part
 Qty. in container
 Is the location able to live-load?                                         Yes      No            <Required>
         If “NO”, explain requested/required loading equipment:


 How many trailers will be needed/what size; ie 53’or 48’                      qty     trailer size
 Can flat bed trucks be utilized?                                           Yes      No
 Does the location have a dock?                                             Yes      No
 Is on-site processing allowed?                                             Yes      No
 Does the location have a certified truck scale?                            Yes      No
 Is this location closing?                                                  Yes      No Date:
 Is this material causing an environmental or safety hazard?                Yes      No
           Explain:
 Additional Comments:



 All fields required (tab to each records):
                       Length   Width   Height            Weight                               Type of Plastic
           ID                                                           Quantity
                         (in)    (in)     (in)             (lb)                        (HDPE, EPP, ABS, LDPE, EPS, etc.)




 (Tab to continue adding records)
 Include photos and formatted data sheets with submission.

 When Section 1 is complete, e-mail this form to GM Global Containerization: maurice.davis@gm.com

 When shipments for recycling are complete, the Requesting Location is to;



 GM GLOBAL CONTAINERIZATION1120 FORM, REV H               Page 1 of 2
  GM Global
Containerization                              Recycling Authorization and Confirmation Form
  Recycling                                    for Shipping Racks, Containers, and Dunnage
  1120 Form
     1. Send this form along with copies of all the shippers showing GM Purchase Contract #, item code,
        container number, quantity, and weight to GM Global Containerization; (email
        maurice.davis@gm.com) or (Fax: 586-575-7696)
     2. Send copies of the SHIPPERS ONLY to Corporate Material Brokering (Fax: 602-797-6596).

 Section 2– to be completed by GM Global Containerization
  Date send ______ _________ to GM Scrap Buyer Name:________________


            SCRAP/RECYCLING DETERMINED BY:

                                              PHONE:

   Global Containerization Authorization Date:

                     GM MANAGER’S SIGNATURE:




  Section 3 – to be completed by the Disposal Source
 I acknowledge the above described scrap racks, containers and/or dunnage are received without any warranty, including any warranty
 of merchantability or fitness. I agree on the behalf of the Scrap/Recycling source identified below to remove from such racks,
 containers and/or dunnage all identification referring to General Motors, and to crunch-up, melt down or otherwise mutilate such
 goods so that they may not be resold for use as racks, containers and/or dunnage or otherwise for the purposes initially intended.

 Company Name:                                                                  Date:

 Address:                                                                     Phone:

 Print Name:

 Authorized Signature:

 Total Quantity:              Total Weight (lbs):           GM Contract ID #:               Date Completed:

 Disposal Source must:
     1. E-Mail completed Section 3 of the NLOC1120 form AND copies of each scale ticket for each shipment
        received to: GM Global Containerization - email address: maurice.davis@gm.com or fax (586-575-7696)
     2. Fax copies of the weight tickets to Corporate Material Brokering (Fax: 602-797-6596).




 GM GLOBAL CONTAINERIZATION1120 FORM, REV H             Page 2 of 2

				
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posted:11/23/2011
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