Notice Of Operational Status Form 2014
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1Division of Recycling/Certification Unit
801 K Street, MS 15-59, Sacramento, CA 95814
(916) 324-8598 (phone), (916) 319-7153 (fax)
CalRecycle.ca.gov
State of California
Edmund G. Brown Jr., Governor
Department of Resources Recycling and Recovery
- Notice of Operational Status -
To notify the Division that you have become operational, please print this form, complete it, sign
and return to the attention of your certification specialist. If you have questions about this form,
please contact your certification specialist or our main line number at (916) 324-8598.
- You can fax the completed form to: (916) 319-7153.
- You can email the completed form to: DORCertFileRoom@CalRecycle.ca.gov
- Or mail it to us at:
CalRecycle, Certification Unit
ATTN: Your certification specialist’s name
801 K St, MS 15-59
Sacramento, CA 95814-3533
Thank you,
The Certification Unit Staff
Clear
Print
Certified recycling centers and processors are required to become operational within sixty (60) calendar
days of their approval date. In addition, the operator must notify CalRecycle within five (5) calendar
days of the actual date the facility begins redeeming or purchasing empty beverage containers.
Complete the items below and return to CalRecycle
after
within FIVE (5) days
you have begun operating.
Certification #: ____________________ Operational Date: ____________
Facility Name: _______________________________________________
Facility Address: _____________________________________________
_____________________________________________
Printed Name: __________________________ Title: ________________
Email: ____________________________ Phone: ___________________
By signing this card,
a.
I affirm that I have obtained all applicable local, county, state, and federal permits,
authorization and licenses required for operation of this facility.
b.
I declare under penalty of perjury under the laws of the State of California that all infor-
mation on this document is true and correct and that I am authorized to sign this form.
Signature: _____________________________________________Date: _____________________
Do not return card to CalRecycle prior to your actual operational date.
11-54 (Rev 1/14)
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