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State of California — California Enviro,.ntal Agency Dement of Toxics Substances Control <br />\1l <br />10 \r <br />Linda S. Adams <br />secretary for Certified Appliance Recycler Application <br />Fsvimnmerxal Protection <br />Please submit to: <br />Department of Toxic Substances Control <br />Attn: Consumer Products Section- CAR application <br />1001 '1' Street, 11th Floor <br />P.O. Box 806 <br />Sacramento, California 95812-0806 <br />Or <br />CAR@dtsc.ca.gov <br />Before you may remove "materials that require special handling' (MRSH) from a major appliance, you must be <br />approved as a Certified Appliance Recycler, pursuant to Health and Safety Code Section 25211 et seq (AB 1447, <br />2007). You must also provide evidence of your CAR status to scrap metal facility. <br />Once a certificate is issued, DTSC will notify the certified uniform program agency (CUPA) in your jurisdiction <br />responsible for inspecting the certified appliance recycling facility. <br />Certificates issued will be valid for three years. Once your certification has expired, you are no longer a Certified <br />Appliance Recycler. In order to continue operating as a CAR, you must renew your certification before the expiration <br />date. <br />Please note: Any changes to the information provided on the Certified Appliance Recycler Application must be <br />® Renewal for CAR Number: 0346 Please note: Entire application must be completed. <br />1. Business Information <br />Business name under which the applicant operates: St Joseph's Medical Center <br />Physical Address: 1800 North California Street, Stockton, California 95204 <br />Mailing Address: 1909 Cemetery Lane, Stockton, California 95204 <br />Catholic Healthcare Wcst 2 <br />Business Phone Number: ( 209 ) 467-6308 Business Owner Name: (D.B A. St. Joseph's Medical Center) <br />Owner -Address: 185 Berry Street, Suite 300, Lobby 2, San Francisco, California 94107 <br />Owner Phone Number: ( 415 ) 438-5500 Email Address (if available): john.Stagg@chw.edu <br />2.) Hazardous Waste generator identification number: EPA# CA0078796406 <br />3.) Is your organization required to obtain a stone water permit? ❑ Yes ® No <br />4.) Is your organization required to file a hazardous materials business plan? ® Yes ❑ No <br />5.) Tax identification number, assigned by the Franchise Tax Board: 94-1196406 <br />6.) Attach a copy of a business license to this application. <br />7.) If applicable, attach a copy of conditional use permits issued by the appropriate city or county to this application. <br />DTSC 1428 (11104/2010) page 1 of 2 <br />