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2217 – Appliance Recycler Program
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PR0518324
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COMPLIANCE INFO
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Entry Properties
Last modified
8/31/2018 2:03:33 PM
Creation date
8/31/2018 1:56:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2217 – Appliance Recycler Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0518324
PE
2217
FACILITY_ID
FA0005630
FACILITY_NAME
CENTRAL VALLEY WASTE SERVICES
STREET_NUMBER
1333
Direction
E
STREET_NAME
TURNER
STREET_TYPE
RD
City
LODI
Zip
95241
APN
04908045
CURRENT_STATUS
01
SITE_LOCATION
1333 E TURNER RD
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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State of California — California Environmental Pion Agency 10 Department of Toxic Substances Control <br />Form DTSC 1430 - Certified Appliance Recycler Waste Management Certification <br />According to AB 2277 (2004), a Certified Appliance Recycler (CAR) must remove and properly manage'materials that <br />require special handling' from discarded major appliances. (HSC §25211) <br />To document that the'materials that require special handling' were removed from major appliances prior to the appliance <br />being crushed, baled, shredded, sawed, sheared apart or otherwise processed in a manner that could result in the release <br />of these materials; scrap metal recycling facilities receiving appliances that have had 'materials that require special <br />handling' removed, must collect form DTSC 1430 at the time of transaction. Form DTSC 1430 is to be completed by the <br />CAR that removed the materials that require special handling, not by the transporter. Form DTSC 1430 is a written <br />certification signed by the CAR that 'materials that require special handling' have been removed from the appliances listed <br />below, in a manner that maintained compliance with subdivision (a) of Section 25212 of the Health and Safety Code. <br />For appliance recycling information contact: (916) 324-3159. <br />1.) DTSC Certified Appliance Recycler (CAR) Number: <br />Please confirm CAR contact information, associated with above CAR # <br />Name: Phone # ( ) <br />Address: <br />2.) EPA Hazardous Waste Generator Identification Number: <br />(To obtain an EPA ID # complete form DTSC 1358) <br />3.) List the number of appliances next to the correct type for this shipment: <br />Washer: Space Heater: Microwave: <br />Dryer: Boiler: Oven: <br />Refrigerator: Furnace: Stove: <br />Freezer: Water Heater: Other: (please soecifv) <br />Trash Compactor: <br />Air Conditioner: <br />4.) List all facilities that the 'materials that require special handling' removed from the above listed appliances <br />were sent to, or the facilities where the materials will be sent: <br />Type of material: <br />Facility information: <br />Please circle the appropriate: Materials have been sent or Material will be sent to <br />Type of material: _ <br />Facility information: <br />Please circle the appropriate: Materials have been sent or Material will be sent to <br />Type of material: <br />Facility information: <br />Please circle the appropriate: Materials have been sent or Material will be sent to <br />CAR Name / Signature <br />Transporter (if not CAR) / Signature <br />Signature of Person Accepting Shipment <br />DTSC 1430 (03/13/06) <br />Date <br />Date <br />Date <br />
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