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6 UA) ll3 <br /> 5p[ipt CaL rcm,a� i.'tun�a Eno�wna 3lftat prOrc4Mmn.,yen,y f <br /> OeUanmenl of Toxic Substances Control <br /> Form DTSC 1430- Certified Appliance Recycler Waste Management Certification <br /> According to AS 2277 x20041 a Cenified Appliance Recycler ICAR)must remove and properly manage'materials that <br /> require special handling'from discarded major apohances (HSC§252111 <br /> i <br /> To document that the materials that require special handling were refj,oved from major appliances prior to the appliance <br /> being crushed baled,shredded. sawed sheared apart or otherwise p ocessed 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 /> ,:ertification 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(a2 of Section 25212 of the Health and Safety Code, <br /> i <br /> For appliance recycling information contact (916) 324-3159" i <br /> 1 ) DTSC Certified Appliance Recycler(CAR)Number t`]t11r1� <br /> Please confirm CAR contact information,associated with above CAR# <br /> Name: l +-I1�2—t Phone# <br /> Address �Oo27S Q�a�O/Qcei2ds✓/� �'�' �4a__c � <br /> 2 ) EPA Hazardous Waste Generator Identification Number Coo <br /> • i t o ob,am an cin,,,o complete form DTSC 13581 <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 -T- Stove — <br /> Freezer. Water Heater 'r - Other (please specify) - <br /> Trash Compactor __ _ _ Air Conditioner ---- <br /> 4 1 List all facilities that the'materlals that require special handling removed from the above listed appliances <br /> were sent to,or the facilities where the materials will be s}:nt. � <br /> Type of material <br /> 4. <br /> Facility information: /Q <br /> Please circle the appropriate: Materials Kve been sant or"_Material will be sent to <br /> 7 <br /> Type of material: � -'--- <br /> Facility information iZ i_•,tr.�Lr, V C a4�? .�' )`t• t •4" t 1,,�' - C <br /> Please circle the appropriate. Materials have been sent of Matenal will be sent to � <br /> =^1 <br /> Type or matenal <br /> Facility information <br /> Please arcie 11, ropn ate �,laterials h.a�,e neer sent or ALatena(�,mll be sent to <br /> -44 q <br /> CARFla�ra 'mature Dale <br /> ' spert:r t C:1P. . 5; -- <br />