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1] <br />gyp. <br />State of California —California Environmental Protection Agency Department of Toxic Substances Control <br />SEP 14 2015 <br />Notification for Exporting Electronic Waste NUIR®NMENTA! <br />Instructions CR I ' —U ncpn OTLICn IT <br />• This notification must be submitted to DTSC and your CUPA at least 60 days prior to the initial <br />export of electronic devices, CRTs, or CRT glass to be in compliance with 22 CCR Section <br />66273.40. <br />• Completion of this notification is valid for the facility addresses indicated in this document, and <br />expires one year after the shipment "begin date". <br />• You must keep all export related documents, including a copy of this notification, for three years <br />from the first shipment date. <br />• You must also comply with the reporting requirements of the California Public Resource Code <br />Section 42476.5 if you export covered electronic wastes (CRT devices; CRTs; LCD desktop <br />monitors, TVs, and laptops; portable DVD players with LCD screens; or some plasma TVs) <br />I. HANDLER INFORMATION <br />Business Name <br />Mailing Address `baa l C <br />Street <br />State <br />Facility address, if different than mailing address Q991 AL %UautNl P 2 F)aA <br />Street address _ <br />State <br />Phone number X000 9 digit CA or EPA ID number (if applicable) <br />LAi2 020 a3a 49L 1 <br />II. FOREIGN DESTINATION INFORMATION FOR THE MATERIALS EXPORTED <br />Primary Destination <br />Business Name Glwe'-OJt_ oav\ada_ �JQlfJlxtlr}I� <br />Address <br />Country _("'r.,A(A,& )-9, G ;:)M, <br />All points of entry to and departure from each foreign country through which the materials will pass.en <br />route: -to-to-to-to <br />Description of recycling process for electronic devices, CRTs, and/or CRT glass if the foreign destination <br />will recycle these items: <br />DTSC Form 1478 (08/29/10) 1 of 3 <br />