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Linda S Adams <br />Secretary for Certified Appliance Recycler Application <br />nvironmental Protection <br />vironmental Protection Please submit to: <br />Department of Toxic Substances Control <br />Attn: Consumer Products Section- CAR application <br />1001 "1" Street, 11th Floor <br />P.O. Box 806 <br />Sacramento, California 95812-0806 <br />Or <br />ov <br />If you remove "materials that require special handling" (MRSH) from a major appliance, you need to provide evidence <br />to a scrap metal facility that you are a Certified Appliance Recycler, pursuant to Health and Safety Code Section <br />25211 et seq (AB 1447, 2007). <br />Once a certificate is issued, DTSC will notify the certified uniform program agency (CUPA) in your jurisdiction <br />responsible for inspecting the certified appliance recycling facility. <br />Certificates issued will be valid for three years. Once your certification has expired, you are no longer a Certified <br />Appliance Recycler. <br />Please note: Any changes to the information provided on the Certified Appliance Recycler Application must be <br />submitted to DTSC in order for the certification to be valid. <br />Please note: Any changes to the information provided on the Certified Appliance Recycler Application must be <br />submitted to DTSC in order for the certification to be valid. Please note: Any changes to the information <br />provided on the Certified Appliance Recycler Application must be submitted to DTSC in order for the <br />certification to be valid. <br />1. Business Information1. Business Information <br />Business name under which the applicant operates: <br />Physical Address: Onsite Electronics Recycling, LLC <br />4447 S. Airport Way, Stockton CA 95206 <br />Mailing address: <br />4447 S. Airport Way, Stockton CA 95206 <br />Business Phone number: <br />(209)234-7994 <br />Business owner name: <br />Janice Oldemeyer & Ronald Kemp <br />Owner Address: <br />P_0. Box 655, Clements, CA 95227 <br />Owner Phone number: (209) 981-4677 Email address (if available): <br />joldemeyer@aol.com <br />2.) Hazardous Waste Generator EPA Identification Number: CAL 000332292 <br />3.) Is your organization required to obtain a storm water permit? Yes X No <br />4.) Is your organization required to file a hazardous materials business plan? X Yes No <br />5.) Tax identification number, assigned by the Franchise Tax Board: 84-1657614 <br />6.) Attach a copy of a business license to this application. <br />7.) If applicable, attach a copy of conditional use permits issued by the appropriate city or county to this application. <br />8.) In an attached document, describe in detail your ability to properly remove and manage all materials that require <br />special handling (MRSH) (HSC 25211 A(a)). The list below describes the level of detail that DTSC would like to see: <br />