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� <br /> DTSC HEADQUARTERS FaX:916-327-4495 Apr 10 '06 8:50 F�04 <br /> ' - <br /> SftteofCalifomia—CalifamimEnvirol" IffiProtection Agency parlanent 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 /> requestedbelow. 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 /> CRT vacuum release without breaking CRT glass. <br /> C. Yoke removal without breaking CRT glass <br /> D. Process CRTs (CRT glass breakage-without 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 /> El Other(e.g. manufacture of glass)please specffy <br /> E. All of the following documents must be submitted with this form if you have checked I'D"above. <br /> El I have attached documentation estirnafing the cost of facility closure prepared pursuant to title <br /> 2-2,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 /> 1 have attached documentation demonstrating financial responsibility for liability pursuant to title <br /> 22, California Code of Regulations,section 66266.147. <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 ff 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 /> re <br /> ^ <br /> ` <br />