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0 <br />F- <br />L. <br />State of California— California Environmental Protection Agency Department of Toxic Substances Control <br />Estimated rate at which the materials will be exported (Example: 50,000 lbs per month) N l EG E w t i <br />Electronic Devices <br />CRTs <br />CRT GlaSS1,2 <br />Quantity pounds/units Frequency of shipment <br />vnv 1'h <br />SEP 14 2Liti <br />ENVIRONMENTAL <br />HFAI"J ^v]Anr'A' <br />t For used CRTs and unprocessed CRT glass, a copy of your notification to US EPA [40 CFR <br />261.39(a)(5)(i)], and a copy of US EPA Acknowledgement of Consent [40 CFR 261.39(a)(5)(iv)] must <br />also be submitted if you will be exporting used CRTs for reclamation [22 CCR §62673.40(a)(4)(8)7 <br />and §62673.40(b)]. A copy of the one time notification to US EPA (40 CFR 261.41) must be submitted <br />for used CRTs exported for reuse [22 CCR §62673.40(a)(4)(B)81. <br />2 For processed CRT glass, include the following information for the lead smelter/CRT glass furnace: <br />Business Name <br />Address <br />Street <br />Country <br />City <br />Estimated total quantity that will be exported to the destination <br />Electronic Devices <br />CRTs <br />CRT Glass <br />Mode of transportation <br />(check all that apply) <br />E911 -ruck <br />Gail <br />❑ Air <br />❑ Ship <br />Count on <br />(11 OR <br />OR <br />Weight (pounds) <br />�lo�Y+S <br />0.,taC,Coo lbs. <br />Types of container <br />(check all that apply) <br />Gaylord container <br />❑ Shipping container <br />ROther. <br />Spar sodL <br />Volume of shipment (the estimated <br />volume of one full, large shipping <br />container (40 ft x 8.5 ft x 8 ft) is 2720 ft) <br />Electronic Devices <br />CRTs <br />CRT Glass <br />IV. Certification <br />Universal Waste handler name:Tgor� anecy s (rlcS S Signature: <br />Notifications must be submitted to DTSC by certified mail, Return receipt request. <br />Department of Toxic Substances Control <br />Universal Waste Notification and Reporting Staff <br />Attention: Notification to Export Electronic Dev'ices, CRTs, and/or CRT glass <br />P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />DTSC Form 1478 (06/29/10) 3 of 3 <br />