Laserfiche WebLink
0 • <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 Der month) i EC E I V E F <br />Quantity pounds/units Frequency of shipment t <br />Electronic Devices_ SEP 14 2015 <br />CRTs' _ ENVIRONMENTAL. <br />CRTGIass1'2 ShOTnnS W)17Y�iij I4r111.1'jnra4D74lchll <br />CA, 12.0, 000 )b5. <br />1 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)(B)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)8]. <br />2 For processed CRT glass, include the following information for the lead smelter/CRT glass furnace: <br />Business Name <br />Address <br />Street City State Zip <br />Country <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 aooly) <br />©'Truck <br />email <br />❑ Air <br />❑ Ship <br />Count OR Weight (pounds) <br />0— OR <br />OR <br />ul 5(oO icmS <br />g t l a o I OC)O k'05. <br />Types of container <br />(check all that aDol <br />[ aylord container <br />❑ Shipping container <br />ROther: <br />Slicer— <br />IV. Certification <br />Universal Waste handler name: ?e "'eyl c (3- c SL <br />Volume of shipment (the estimated <br />volume of one full, large shipping <br />container (40 ft x 8.5 it x 8 ft) is 2720 It) <br />Electronic Devices <br />CRTs <br />CRT Glass <br />Notifications must be submitted to DTSC by certified mail, <br />receipt request. <br />Department of Toxic Substances Control <br />Universal Waste Notification and Reporting Staff <br />Attention: Notification to Export Electronic Devices, 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 />