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2617 S EI Dorado St, Stockton Record ID PR0521368 <br /> 6/18/2020 HW Inspection <br /> Photo 4: The facility takes scrap appliances to Sims Metal. <br /> ,rf Twr :ur/Marrr:nrAaA <br /> Form DTSC 1430-Certified Appliance Recycler Waste Management Certification <br /> I,c inp to A8 2277(2004),a Cartified Appliance Recycler(CAR)must remove and properly manage'meterials that s <br /> ' ngwre spacial handtinp'from discarded major apps}antes.(H8C 1252 t 1) <br /> 4, To document that the'materials that require special handling'were removed from major appkanow prior to the appliance <br /> being crushed,bated,shredded,sawed,sheared apart or otherwise processed In a manner that could(Sault in the release <br /> of these materials,scrap metai recycling facilities recelving appliances that Have had'materials that require"Cis] <br /> handling'removed,must collect form DTSC 1430 at the time of transaction.Form DTSC 1430 is to be compkated by the <br /> CAR that removed the materials that require special handl) <br /> q pe ng,not by the transporter Form DTSC 1430 is a written <br /> certification signed by the CAR thal'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 /> h For appliance recycling Information contact:(918)324-3159 <br /> 1.) DTSC Certified Appliance Recycler(CAR)Number <br /> Pisase confirm CAR contact information,associated wah above CAR# <br /> Name: J�-✓lt� Z vJ1l`(!.__[b .1At'��Lt✓(Cs�� Phone# U&4 / .i <br /> Address: 2 )) <br /> 2.) EPA Hazardous Waste Generator Idenfification Number:� _LL- J1 <br /> (To obtain an EPA I D#complete form DTSC 135B) <br /> 3.) list the number of applianrsrs neirl to the correct type for this shipment: <br /> Washer: _ Space Heater Microwave; <br /> Dryer: �'� Boder Oven <br /> Refrigerator. Furnace: Stove: — <br /> Freezer Water Heater Other: (please specify) <br /> Trash Compactor: Air Conditioner: <br /> 4.1 List ail facilities that the'materials that require special handling'removed from the above listed appliances <br /> were sent to,or the facilities where the mate6als.wflibesent!_-.. <br /> Type of material. r Y <br /> Facility information:r r.(VI�, w ( f- <br /> Please circle the appropriate: Mat rials have been serrt o Material will be sent tam --•-•....- <br /> Type of material: t� <br /> Facility information forCO,%... - <br /> Please circle the appropriate: Materials have been sent or Material will be sent to <br /> Type of material: l"See UY — �C <br /> r.. <br /> Facility information: .11-d � <br /> Please circle the appropriate: Materials have been sent o C t)> <br /> Materia)will be sent o / <br /> - -f- <br /> �CAR �1 ,gnatule � Date <br /> �Iar, (if not CAR)!Signature Date <br /> Transk T- C <br /> 4 <br /> Signatur of arson Accepting Shipment Date <br /> OTBG�7q 30(03113!06) <br /> John Alaniz, REHS Page 4 of 4 <br />