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State of California — California Environmental Protection Agency <br />Department of Toxic Substances Control <br />E. Cathode Ray Tube Material Treatment [22 CCR section 66273.83(c) or (d)]. Please fill in the information <br />requested below. Attach additional sheets if necessary. Include photographs and diagrams if desired. <br />1. Describe the type of CRT materials you handle and intend to treat and/or recycle. <br />2. Describe the treatment and/or recycling process(es) you will conduct. <br />3. Check the box(es) that best describes your treatment/recycling activities. <br />A. ❑ Removal of CRT from CRT device without breaking CRT glass. [Note: If this is the only <br />treatment you perform, do not fill out this from. Please use Form 1382 instead.] <br />B. ❑ CRT vacuum release without breaking CRT glass. <br />C. ❑ Yoke removal without breaking CRT glass. <br />D. ❑ Process CRTs (CRT glass breakage—without the use of heat, chemicals or water). <br />[You must check one or more below.] <br />❑ Remove necks/electron guns <br />❑ Separate panel from funnel <br />❑ Size reduction, crushing, cutting, sawing, compacting, shredding <br />❑ Other (e.g. manufacture of glass) please specify <br />E. All of the following documents must be submitted with this form if you have checked "D" above. <br />❑ 1 have attached documentation estimating the cost of facility closure prepared pursuant to title <br />22, California Code of Regulations, section 66265.142. <br />❑ I have attached documentation demonstrating financial assurance for closure pursuant to title <br />22, California Code of Regulations, section 66265.143. <br />❑ I have attached documentation demonstrating financial responsibility for liability pursuant to title <br />22, California Code of Regulations, section 66265.147. <br />F. Universal Waste Electronic Device Treatment [22 CCR section 66273.13/.33(d)(3)(F)(1)(a)(4)]. Please fill in <br />the information requested below. Attach additional sheets if necessary. Include photographs and <br />diagrams if desired. <br />1. Describe the types of UWEDs you handle and intend to treat and/or recycle. <br />2. Describe the treatment and/or recycling process(es) you will conduct. <br />3. Check the box(es) that best describes your treatment/recycling activities. <br />DTSC 1388 (11/15/04) Page 3 of 5 <br />