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State of California — California Environmental Agency Linda S. Adams Secretary for Environmental Protection • Department of Toxics Substances Control = � RECEIVED S 2 0 HM o a�: Certified Appliance Recycler Application Please submit to: Department of Toxic Substances Control Attn: Consumer Products Section- CAR application 1001 "1" Street, 11 th Floor P.O. Box 806 Sacramento, California 95812-0806 Or CAR@dtsc.ca.gov RECEIVED MAY 18 2015 ENVIRONMENTAL. HFA; TN nP:oa PTAAFhIT 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 he valid I0 Renewal for CAR Number: D '7 s -q Please note: Entire application must be completed. r.""" IVCs ke i✓t L1� Business name ur)derAwhich the applicant operates: �i'1 Gj , Physical Address: `o�oZo�oZ Sinclair Ay�ue/ 5'hic�}pn, CA GSU2/S Mailing Address: a-jNw,,� Business Phona'Nminber: (r -d I) fl q y—5t)Ut7 Business Owner Name: �C"S Pie fi/i1'r) 6?, k-(f Owner Address: n 5 ��(J 1 S PP r 6A k&q C l L(/-�7 Owner Phone Number( 401)02-00—'7001) Email Address (if available): /n n �/ C o rte 2.) Hazardous Waste generator identification number: O- kz 000 �/ to Ss 9 3.) Is your organization required to obtain a storm water permit? X Yes ❑ No 4.) Is your organization required to file a hazardous materials business plan? , 6.) Attach a copy of a business license to this application. _ y �cJ L�_ 30 T))f applicable, attach a copy of conditional use permitsissuedby the (appropriate //city or county to this application.