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FIGURE 1. Notification to DTSC for LLNL Site 200 to Accept E -Waste from Site 300 <br />FACILITY OWNER OR PROPERTY OWNER INFORMATION <br />' Owner Nam#: FU.S Deparment of Energy <br />'Owner Address: P O. Box 80a. L-293 <br />' Owner City: Lavern ore <br />Owner State: CA -' <br />'Owner Zip: 94551 _ <br />Types of a ectron is wastes expected to fie (Select a`- that apply <br />-Waste <br />Handled: Collected <br />Rec <br />CRT Device <br />[] <br />❑ <br />Bare CR? <br />❑ <br />❑ <br />CRT Glass <br />1 <br />0 <br />LCD Donator <br />❑ <br />Laptop with LCD monitor <br />0 <br />❑ <br />LCD Television <br />❑ <br />❑ <br />Portab* DVD player vrr:h LCD screen <br />❑ <br />❑ <br />Plasma T&evs w+. <br />❑ <br />Cl <br />Mtcrovrave <br />❑ <br />VCR <br />0 <br />❑ <br />Computer <br />13 <br />❑ <br />Printer <br />0 <br />❑ <br />Cellular Phone <br />0 <br />❑ <br />Telephone <br />F1 <br />❑ <br />Radio <br />0 <br />❑ <br />Small Electronics (ie Keyboard, mice. CD payers) (� <br />❑ <br />Large Electronrs (ie Copier, fax machined <br />0 <br />❑ <br />Other Electronic Devices 0 Lrwi —� ❑ <br />Source of eiectrvic devices, bare CRTs and CRT g ass (Select alP, that apply, <br />❑ Businesses <br />❑ 0thera-wastehandlers'cc4t:ors <br />❑ Households <br />❑ Government Agenc+es <br />C1 Otrer LL-Nt- Site 3D4 LLNL Lver -are s+te LLNL offsi_e;1 <br />Prepared by LLNL under Contract DE-AC52-07NA27344. <br />F ILE C E I V E <br />MAR 13 201% <br />