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Marcs or uawornia — r✓ anrorma tnwronmentat Agency Department of Toxics Substances Control G� Linda Adams Secretary for Certified Appliance Recycler Application Environmental Protection R EC E V E 1U) Please submit to : Department of Toxic Substances Control Attn : Consumer Products Section- CAR application DEC 2 6 2013 1001 " 1 " Street, 11th Floor P . O , Box 806 I45NV1120NAl1: N ] 1AL 1-ILAL114 Sacramento, California 95812-0806 D1; p,� 12"Tf� 1LNT Or CAR@dtsc . ca . gov Before you may remove " materials that require special handling" ( MRSH) from a major appliance, you must be approved as a Certified Appliance Recycler, pursuant to Health and Safety Code Section 25211 et seq (AB 1447 , 2007) . You must also provide evidence of your CAR status to scrap metal facility. Once a certificate is Issued , DTSC will notify the certified uniform program agency (CUPA) in your jurisdiction responsible for inspecting the certified appliance recycling facility . Certificates issued will be valid for three years . Once your certification has expired , you are no longer a Certified Appliance Recycler. In order to continue operating as a CAR , you must renew your certification before the expiration date. Please note : Any changes to the information provided on the Certified Appliance Recycler Application must be submitted to DTSC in order for the certification to be valid , ❑ Renewal for CAR Number: � - l ' ` Please note: Entire application must be completed. 1 . Business Information II Businessname under which the applicant operates: 045rr 61tct� � oat. CS 13ecycl Physical Address : 531 eeRee Dr 5 +aA vn CA 9 5a o 5 Mailing Address: v� 33 I S G o� C S +DcOar Cly 5 a o 5 Business Phone Number: ( o ) � 3 `i - 799 y Business Owner Name : .� GLA � cC 01c atie , gr tm Rarfo. ld Kew, � Owner Address : 3gol i of ry r , J $ c RJt"or � Cottc ^ S CZ) SOS 01 `{ Owner Phone Number: ( 9 ) q `� 1 - 14 677 Email Address (if available) : o (h 2yew !� �� oC'1 , Co rl 2 . ) Hazardous Waste generator identification number: CAR 000 AS 7 5 19 3 . ) Is your organization required to obtain a storm water permit? ® Yes ❑ No 4 . ) Is your organization required to file a hazardous materials business plan ? Yes ❑ No 5. ) Tax identification number, assigned by the Franchise Tax Board : `� H ' 1 6 57 G i N 6. ) Attach a copy of a business license to this application . 7. ) If applicable , attach a copy of conditional use permits issued by the appropriate city or county to this application . nTAr: 9428 M11n4/2nini , „f „