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Slate of Cahfmnia California Etlw Jaat?INJI Piale,-tmn ayen�y ti' - <br /> _ Department of Taxlc Stibslmiu s Control <br /> Form DTSC 1430 - Certified Appliance Recycler Waste Management Certification <br /> .4ccbrding to AS 221:20041 a Certdted Appliance Recycler ICAR)must remove and properly manage'materials that <br /> require special handling'from discarded major appliances (HSC§252111 <br /> I <br /> To document that the'matenals that require special handling were reproved from major appliances prior to the appliance <br /> being crushed baled,shredded. sawed sheared apart or Otherwise pfocessed 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 /> .:ertlfication signed by the CAR that'materials that require special handling have been removed from the appliances listed I <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 Ig16) 324-3159. i <br /> 1 ) OTSC Certified Appliance Racycler ICAR)Number: <br /> Please confirm CAR contact Information.associated with above CAR 9 <br /> Namw l r�l>a_t�k'S '� Phone# _(arta <br /> Address' <br /> 2.) EPA Hazardous Waste Generator Identification Number 000 � <br /> 11 o ebtam an cr n ru v complete form DTSC 1358) <br /> 3) List the number of appliances next to the correct type for thus shipment <br /> Washer _ Space Heater' Microwave <br /> Dryer -- - Boiler _---_—_ - Oven <br /> Refrigerator Furnace: T Stove <br /> Freezer: Water Heater Other — -- <br /> Trash Compactor _ Air Conditioner (Please specify) <br /> 4 ) List all facilities that the'materials that require special handlingremoved from the above listed appliances <br /> were sent to.or the facilities where the materials will be stint. <br /> Typeotmaterlal r-. c •2�' <br /> Facility information: <br /> Please circle the appropriate: Materials Ifeve been sent or Material will be sent to <br /> 1 <br /> Type of material: 2–� <br /> Faahtymformation LZ% e�krlr� - ��; '1 }•p .c, i It" <br /> Please circle the appropriate. Materials have been sent ar Matenal will be sent to <br /> Type of matenal <br /> Facility information <br /> Please circle th opriMe fylatenals 1,3•,e beer sent or 6laterisi mil be sent to <br /> CARId311'e Srjoature (} D le <br /> — <br /> Dir? <br />