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0 <br />State of California—California Environmental Protection Agency Department of Toxic Substances Control, <br />Notification for Exporting Electronic Waste SEP 14 2015 <br />r° This � IIL0 RACKIT L <br />• This notification must be submitted to DTSC and your CUPA at least 60 days prior o. con eecniT <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 py cWae S14- C, <br />Mailing Address 'IDLar. S . S -1,A n i ( <br />Street <br />Facility address, if different than mailing <br />Street address <br />City State Zip <br />Phone number 2@a- rf /�i 5000 9 digit CA or EPA ID number (if applicable) CtMacri'M q3-6, <br />II. FOREIGN DESTINATION INFORMATION FOR THE MATERIALS EXPORTED <br />Primary Destination <br />Business Name GIeAA COJti ('('.V\CQC`a- �t�� QnratlAn <br />Address <br />Street City <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 />a it � � � e '• a � �"LI <br />DTSC Form 1478 (06/29/10) 1 of 3 <br />