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DTSC HEADQUARTERS Fax>916-327-4495 Apr 10 '06 8:49 P.02 <br /> S to Of California—Calif ia.Enviroir rotection Agency Opartment of Toxic Substances control <br /> Notice Intent to Handle and Treat or Recycle <br /> Universal Waste Electronic Devices ( ) and/or Cathode Ray Tube (CRT) Materials <br /> A. Handler Information[22 CCR sections 66273.131.33O(2)O(1)-(7)and 673. (a)(1)-(7)]. Please fill in <br /> the information requested below. <br /> Handler(Facility)Name QmAer_ a C.5 . i6cV8,ora iIKC Phone(_) X69-qa. _ <br /> Physical Address F ;393 i&A Lo-place n� CA 4533L <br /> Street City County State Zip <br /> Mailing Address '1 # 33`? fl5r r 'Jgd-fa C1}_—M-05-10 <br /> Street City County State Zip <br /> Contact Person(NamefTitie) n+c e e yew re,a - Phone(.&6) 9q 6 <br /> Failing Address _ o"1 in)> Las 33-7_ M o.roo.,-k Q,vJwvv CA 230,24 <br /> treet City �® County State Zip <br /> Facility Owner_ n ComA, AtAA: A^8%e tees Phone <br /> Mailing Address t?o, 6oy, tSlo C� �o' <br /> Street City County State Zip <br /> E-Mail address J bt. Maj P- Con (if available) <br /> EPA ID Number NIA (if applicable) <br /> B. Proposed Handling Activities 122 CCR sections 66273.1303( )(2)(A)(8)-( )and 66273.82(x)(8)-(9)]. <br /> Please check the box(es)that describes the source(s)of the materials you will collect. Please check the <br /> box(es) that describes the types of materials you will collect. Check aU applicable boxes. <br /> Materials Accepted From: Materials to Be Handled <br /> (Check all that apply) <br /> CK Businesses Cathode Ray Tube Materials <br /> Households universal Waste Electronic Devices <br /> Government agencies Universal Waste Batteries <br /> Other collectors Universal Waste Lamps <br /> Other please specify /den-9r%C'.+ Scrap Metal <br /> C. Please <br /> specify where you intend to send the materials you will receive from offsite sources. If you intend to <br /> export materials,please complete" "below. Attach additional sheets if need <br /> Destination Facility or Handier Materials Shipped <br /> (Check all that apply) <br /> 1: Name mLac,48e Inc- Phone(670} - 07 Bare CRTs <br /> Address ; ' 1� &)30 Olak 151poil PA 18'99- CRT Devices <br /> CRT glass <br /> S reet City State Zip UWEDs <br /> Universal Waste Batteries <br /> Country 066 Phone5{ 1,0j C] Universal Waste lamps <br /> Mailing Address Q® Sox Selq A- SSR- ❑ Scrap Metal <br /> Street City State Zip <br /> Country V5 <br /> EPA ID number Q %041 ? (if applicabl®) <br /> OTSC (10104) Page I ors <br />