Laserfiche WebLink
State of California — California Environmental Agency Department of Toxics Substances Control <br /> Linda S. Adams Certified Appliance Recycler Application <br /> Secretary for <br /> Environmental Protection <br /> Please submit to: <br /> Department of Toxic Substances Control <br /> Attn : Consumer Products Section- CAR application <br /> 1001 "I" Street, 11th Floor <br /> P.O . Box 806 <br /> Sacramento, California 95812-0806 <br /> Or <br /> CAR@dtsc.ca, gov <br /> Before you, may remove "materials that require special handling" (MRSH) from a major appliance, you must be <br /> approved as a Certified Appliance Recycier, pursuant to Health and Safety Code Section 25211 et seq (AB 1447, <br /> 2007). You must also provide evidence of your CAR status to scrap metal facility. <br /> Once a certificate is issued , DTSC will notify the certified uniform program agency (CUPA) in your jurisdiction <br /> responsible for inspecting the certified appliance recycling facility. <br /> Certificates issued will be valid for three years. Once your certification has expired , you are no longer a Certified <br /> Appliance Recycler. In order to continue operating as a CAR, you must renew your certification before the expiration <br /> date. <br /> Please note: Any changes to the Information provided on the Certified Appliance Recycier Application must be <br /> submitted to DTSC in order for the certification to be valid . <br /> Renewal for CAR Number: ^0 {"t Please nota; Entire application must be completed . <br /> 1 . Business information <br /> Business name under whhiic-h, the applicant operates: tSl MS mew tYlo &oeivt.exib <br /> Physical Address : 1Otx.� '5DL)JAx nuf arts ZAxeieA ' S ki+ . Cts <br /> . . _MailingAddress & . 100kee.� " +oc- m � CA �l' Z U <br /> Business Phone Number: ( } �� �/000 t3usiness Owner Name . CSt rns mesa Q f� ` :f�tQ <br /> Owner Address : QQ � CN-( � - cry , �� 1 C4 6,64 <br /> Owner Phone Number: ( .Si } LQ " 5300 Email Address (if available) ze 14er 51 n)s m XOOM <br /> _ 2 ' Hazardous Waste generator identification number: C AD 0 29 q9 st>7 L <br /> 3 ) Is your Organization required to obtain a storm water permit? ® Yes ❑ NO <br /> 4 . ) Is your organization required to file a hazardous materials business plan? c-� (yl Yes ❑ No <br /> 5. ) Tax identification number, assigned by the Franchise Tax hoard : -j <br /> 6. ) Attach a copy of a business license to this application. <br /> 7. ) if applicable , attach a copy of conditional use permits Issued by the appropriate city or county to this application . <br /> page 1 of 2 <br /> DTSC 1428 ( 11 /04/2010) <br />