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( State of California-California Environmental Protection Agency <br /> Department of Toxic Substances Control <br /> Certified Appliance Recycler Application O <br /> Submit to: <br /> Department of Toxic Substances Control <br /> Hazardous Waste Management Program <br /> 1001 "1" Street, 11 th Floor <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> If you transport, deliver, or sell discarded major appliances to a scrap recycling facility, after January 1, 2006 you <br /> will need to provide evidence that you are a certified appliance recycler, pursuant to Health and Safety Code 25211 <br /> (AB 2277, 2004).After July 1, 2005, if you wish to operate as a certified appliance recycler you will need to submit <br /> this application to the Department of Toxic Substance Control (DTSC), to obtain certification. As of January 1, 2006 <br /> scrap recycling facilities will be prohibited from accepting a discarded major appliance from any person who is not a <br /> certified appliance recycler. <br /> 1.) Business name under which the recycler operates: ,i ,,� ��, J ju 1 ti�;r J ;Ct' � ��; .(i�� L1--LC - <br /> Applicant name: LO t t 2LQA"*- <br /> Phone number: ` <br /> 2.) Business owner information: <br /> l V <br /> Name: t✓ ��� �>�� 1. � �t�t <br /> Address: 3 2-e C> <br /> Phone: L.c'cj" <br /> 3.) Hazardous Waste generator identification number: EPA ID# <br /> (If required.If you need to obtain an EPA ID#call: 1-800-618-6942) <br /> y' <br /> 04.) Applicant has filed an application for a stormwater permit; or YES / NtT r <br /> t <br /> Applicant is not required to obtain a stormwater permit. <br /> 5.) Applicant has filed a hazardous materials business plan; or E Nb <br /> Applicant is not required to file the plan. CDRFgECT <br /> 6.) Tax identification number, assigned by the Franchise Tax Board: <br /> 7.) Attach a copy of a business license and any conditional use permits issued by the appropriate <br /> city or county. <br /> DTSC 1428(04/21/2005) <br /> 1 of 2 <br />