Notice Of Intent To Handle And/or Treat Or Recycle Template
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4State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Notice of Intent to Handle and/or Treat or Recycle
Electronic Devices, Cathode Ray Tubes (CRTs) and/or CRT glass
Universal Waste Handlers must notify DTSC 30 days prior to accepting and accumulating e-wastes (unwanted electronic
devices, CRTs, and/or CRT glass) from offsite sources. Handlers may remove batteries and ink cartridges, and remove
CRTs from CRT devices [Title 22 of the California Code of Regulations (CCR) Sections (§) 66273.71 and 66273.72(b)]
but may not perform any recycling activity indicated below without notifying as a recycler. Handlers must fill out pages 1
and 2 of this form.
Universal Waste Handlers dismantle or treat electronic devices, remove yokes from CRTs, treat or break CRT glass, or
treat printed circuit boards [22 CCR §s 66273.72(c) and 66273.73 (a) and (b )] (Recyclers) must notify DTSC 30 days
prior to accepting, accumulating, and treating e-wastes. Recyclers must fill out the whole form.
In addition to this one time notification, recyclers and handlers must also submit any export notifications at
least 60 days prior to exporting any electronic device, CRT, or CRT glass out of the country, and recyclers
and handlers must also submit a completed annual report by February 1 of each year.
Section A. Business Information [22 CCR § 66273.32(c), 66273.74 (a)] (Handlers and Recyclers)
If new collection events are being added to an existing business, please check here
and fill out Section A, B, and C.
Business Name: _______________________________________
________
____
___
Phone (____) _______________________
Mailing Address: __________________________________________________________________________________
City: _________________________ County: ___________________ State: _______ Zip: ___________
Contact Person Name: _______________________________________ Title: ________
____
_
Phone (____) ____________________ E-Mail address: _____________________________________
Section B. Physical location(s) (Handlers and Recyclers)
All Business Information must be the same for the facilities listed below. Use additional pages, as necessary. A
new
1388 form
must be submitted if a facility conducts any treatment activity (See page 3).
Physical Address, city, state, zip (Check here if address is the same as the mailing address
):
____________________
____________________________
_____________________
County: __________________________
EPA/ State ID Number (if applicable): ___________________________
Facility Owner Name _______________________________________________ Phone (____) __________________
Owner Mailing Address (Recycling facility only) ______________________
_____________________
City: ___________________________ County: __________________ State: ______ Zip: __________
Are there any changes from activity indicated in Section C? _____________________________________________
___________________________________________________________________________________________
DTSC 1388 (04/01/10)
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