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DTSC HEADQUARTERS Fax:916-327-4495 Apr 10 '06 8:51 P.05 State of California California Eoi'—wProtection Agency Spartrrient of Toxic substances Control nvir 3. Check the box(es)that best describes you"r treatment/recycling activities. A. Removes discrete components typically removed during the normal operation of the UWED (batteries, ink cartridge, etc.)and the handler conducts the disassembly in a manner proscribed in the operating manual for the device. [Note: If this is the only treatment you Perform, do not fill out this,from. Please use Form 1382 instead.] B, Dismantling UWEDS into only their respective components using, Manual methods and hand tools or mechanical separation of parts only. Other please specify Treatment residuals are components of the electronic device(e.g., circuit boards, integrated circuits,metals, plastic,wiring,universal waste batteries and lamps,etc.) C. C3 Processing(Without heat,chemicals or water) E] Shred or cut,etc.,whole or parts of UWED after removing batteries, lamps,and other universal wastes. El Components of UWEDs are processed after removal(e.g.,'circuit boards,chips, other components). 13 Resultant materials generated from treatment are scrap metal and universal waste batteries and lamps. D. Processing(without hear.chemicals or water) Size reduction,crushing, cutting,sawing,compacting, shredding Separation technology ❑ Other please specify Treatment residuals exhibit a hazardous waste characteristic and do not moot the definition of scrap metal or do not qualify for management as universal waste. E. Ail of the following documents are required if you have checked"D"above. I have attached documentation estimating the cost of facility closure prepared pursuant to tide 22,California Code of Regulations,section 66265.142. El I have attached documentation demonstrating financial assurance for closure pursuant to title 22,California Code of Regulations,section 66265.143. I have attached documentation demonstrating financial responsibility for liability pursuant to title 22,California Code of Regulations,section 66265.147. Rropey Owner Notification[22 CCR sections 66273.131.33(d)(3)(F)(1)(a)(6)and 66273.83(c)(2)(A)(2)(e)or I have attached documentation demonstrating that 1,the CRT material handler and/or UWED handler, has notified the property owner(if different from the handler)that I am conducting hazardous waste treatment and recycling operation(s)at the facility pursuant title 22,California Code of Regulations,division 4.5,chapter 23(Universal Waste Regulations). EJ 1, the CRT material handler and/or UWED handler,am the property owner of the facility specified in Section 'A", F—H-1—ni—pection 911, the CRT material handler and/or UWED handler, am aware that the facility specified in Section"A7 is subject to unannounced in*poctiona by state or local agencies to verify compliance witri applicable universal waste regulations, air DT3C)00(X(10104) Page 4 of 5