Laserfiche WebLink
� [ " <br /> State of California—CalUornia Envirom .al Agency De hent of Toxics Substances Control <br /> � <br /> M31 TOF <br /> 5C0HTR0L <br /> HUD 15 PM 4: 58 <br /> Linda S.Adams <br /> Secretary for Certified Appli;�.knM-RecyclertAl2plication <br /> Environmental Protection <br /> Please submit to: �=���� ° �8��B~� <br /> Depo�muntofToxic Sub�ano*uConbn| ' m &&~=�~���K <br /> Attn: Consumer Products Section- CAR application <br /> 1001 ^|''Street, 11th Floor SIP 7 2018 <br /> P.O. Box 806 <br /> Sacramento, California S5812-000G ENVIRONMENTAL. <br /> Dr HEALTHDE � <br /> R4� NENT <br /> CAR��dtoo.oa.gov <br /> Before you may remove"materials that require special handling"(MRSH)from a major appliance, you must be <br /> approved as a Certified Appliance Recycler, pursuant to Health and Safety Code Section 25211 et seq (AB 1447, <br /> 2007).You must also provide evidence of your CAR status to scrap metal facility. <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. In order to continue operating as a CAR, you must renew your certification before the expiration <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 /> WURenewal for CAR Number: Please note: Entire application must becompleted, <br /> 1. Business Information <br /> u iness name under which the applicant operates: 5C 5 PZ <br /> Physical Address:- )� <br /> Mailing Address: <br /> Business Phone Number: Business Owner Name: <br /> Owner Address: ^^ <br /> Owner Phone Number: Email Address (if avai|ab|e>: <br /> 2j Hazardous Waste generator identification number: <br />� <br /> 3j |oyour organization required boobtain astorm water permit? Yes No <br /> 4.\ |syour organization required to file a hazardous mobaha|n business plan? 01 Yes Fl No <br /> 5.)Tax identification number, assigned bythe Franchise Tax 8oard: � <br /> � <br /> 8]A�aoh a copy of business license hn this application. <br /> ' � <br /> 7j If applicable, attach a copy of conditional use permits issued by the appropriate city or county to this application. <br /> DTSC142O(11/04/2010) page 1of2 <br />