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Calornia Department of <br />Toxic Substances Control <br />Handl6rCertifica.on Pane.(S!gq ure.Required� <br />Nemo: Centel Whey waste Swwoes, to: WN <br />• (Rew ed) <br />• Rspmft Year �+� <br />' 1. the CRT and/or OWED handler, ran r the property owner g the operator of the fadlty. <br />J wft under penalty of Me law that the faculty, rwmed in Section A, 98WEdOe or accepts itom off 8119, but <br />does not treat or recycle, universal wash alsot ai Ic devlcee and/or CRT meierfal8. The WommMon =.tsined <br />In 9119 rwtlAMeeL--- <br />e truaomplsie m the test of my knowledge. <br />''•,1}r(�t7�' ' DWIct Manager <br />Signature (non -black ink) • Title (please type in) <br />Brian Waters 11!19!2008 In <br />• PrInted Name (please we IN . " Dow *nod (wwWddlyyyy - p6me type in) <br />Nodketions must be submitted to OTSC by cerVed meq r*Wm reaelpt request. <br />Before submitting We page, ! "KI it out, so you can sign and send It to address belew. <br />Man to: Department of Toxic Substance Control <br />Hazardous Woete Manspernent Propwam <br />Regulatory Program Davelopawent DMslon <br />P.O. BOX 8011 <br />Saerentento, CA 96812.0808 <br />Attention: UWEDICRT MtlWWa Handling Activities <br />Your appncetlon wM not be accepted H You do not complete and send in this page. <br />hV://& C.c&gov/databeaMmWOWE Update CedWwahOII eft?usar OOd -CantWV... 11/19/21XIS <br />