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State of California—California Environmental Protection Agency <br />Alternate Destination for materials exported <br />• <br />Department of Toxic Substances Control <br />IF. CEIVE <br />SEP 14 2015 <br />Business Name <br />„� MENTAL <br />Address a'T a nCO OTtaCKIT <br />Street City State Zip <br />Country <br />Alternate Destination for materials exported <br />Business Name <br />Address <br />Street City <br />Country <br />Ill. SHIPMENT INFORMATION <br />Duration of shipments to foreign destination: <br />Notification date: A <br />State Zip <br />Shipment "begin date" (must be at least 60 days after "notification date"): <br />Shipment "end date" (must not exceed 12 months after shipment "begin date"): Cill 11(12 <br />Types of materials sent to foreign destination: <br />Will you export any of the following? <br />• Intact Cathode ray tubes (CRTs) (with yokes attached) No [t es ❑ <br />• CRT containing devices (including monitors and TVs) <br />No [9'Yes ❑ <br />• LCD desktop monitors or TVs <br />No EOYes ❑ <br />• laptops or portable DVD players with LCD screens <br />No R Yes ❑ <br />• plasma TVs (excluding plasma projection televisions) <br />No [I]'Yes ❑ <br />If yes for any above listed materials, you must also submit the following documentation demonstrating <br />the following at least 60 days prior to exporting (California Public Resource Code Section 42476.5): <br />• the waste or device is being exported for the purposes of recycling or disposal <br />• the importation of the waste or device is not prohibited by an applicable law in the state or country <br />of destination and that any import will be conducted in accordance with all applicable laws <br />• the exportation of the waste or device is conducted in accordance with applicable United States <br />or applicable international law <br />• the waste or device will be managed within the country of destination only at facilities whose <br />operations meet or exceed the binding decisions and implementing guidelines of the Organization <br />for Economic Cooperation and Development for the environmentally sound management of the <br />waste or device being exported. <br />For additional information, see our Q & A document on exporting Covered Electronic Devices" <br />DTSC Form 1478 (06/29110) 2 of 3 <br />