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State of California-California Environmental Protection Agency Department of Toxic Substances Control <br /> 6.) Tax identification number, assigned by the Franchise Tax Board: `fs �— 0S <br /> S <br /> 7.) Attach a copy of a business license and any conditional use permits issued by the appropriate <br /> city or county. <br /> 8.) Describe your ability to properly remove and manage all Materials that Require Special Handling(MRSH). <br /> Including, but not limited to: (HSC 25211.4(a)(7)) <br /> A description of the ability of the applicant to properly remove and manage all MRSH, including but not <br /> limited to, a technical description of how each MRSH will be removed and a description of how each <br /> MRSH will be managed by the applicant consistent with applicable laws. <br /> (Use additional pages as necessary.) <br /> Certificates issued will be valid for three years. Once your certification has expired, you are no <br /> longer a certified appliance recycler and may no longer operate as a certified appliance <br /> recycler. <br /> Once a certificate is issued, DTSC will notify the certified uniform program agency(CUPA) in <br /> your jurisdiction,which is responsible for inspecting the certified appliance recycling facility. <br /> If denied, DTSC will explain to you why your application failed to meet the requirements for <br /> certification. <br /> DTSC may revoke or suspend a certification issued. <br /> Signature: Date: <br /> DTSC 1428(1/2512008) 2 of 2 <br />