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State of California - California Environmental Protection Agency Department of Toxic Substances Control <br />Certified Appliance RecVcler Application <br />Submit to: <br />Department of Toxic Substances Control <br />Hazardous Waste Management Program <br />1001 "1" Street, 11th Floor <br />P.O. Box 806 <br />Sacramento, California <br />If you transport, deliver, or sell discarded major appliances to a scrap recycling facility, after January 1, 2006 you <br />will need to provide evidence that you are a certified appliance recycler, pursuant to Health and Safety Code 25211 <br />(AB 2277, 2004). After July 1, 2005, if you wish to operate as a certified appliance recycler you will need to submit <br />this application to the Department of Toxic Substance Control (DTSC), to obtain certification. As of January 1, 2006 <br />scrap recycling facilities will be prohibited from accepting a discarded major appliance from any person who is not a <br />certified appliance.redycler. <br />1.) Business name under which the recycler operates: _ z Epp - 419jok /29 4 F— <br />Applicant name: .LPJ'f-b /-.4-M A AJ <br />Phone number: 2-001-36 E-26-3 3 <br />2.) Business owner information <br />Name: /9 /YeM ILK AIA <br />Address: 2!2 9 Z S /o/)�:- 5S <br />Phone: 2n9-269-17-99 <br />3.) Hazardous Waste generator identification number: (EPA ID #) xlsn- CaExl tJ'�� <br />(If required. If you need to obtain an EPA ID # call: 1-800-618-6942) <br />4.) Applicant has filed an application for a stormwater permit; or <br />AApLica nt is not required to obtain a stormwater pe[mit. e( <br />5.) Applicant has filed a hazardous materials business plan; or <br />Applicant is not required to file the plan p <br />6.) Tax identification number, assigned by the Franchise Tax Board: <br />7.) Attach a copy of a business license and any conditional use permits issued by the appropriate <br />city or county. <br />DTSC 1428 (04/21/2005) <br />1 of 2 <br />10 <br />