DTSC Form 1430 "Certified Appliance Recycler Waste Management Certification" - California

What Is DTSC Form 1430?

This is a legal form that was released by the California Department of Toxic Substances Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 9, 2019;
  • The latest edition provided by the California Department of Toxic Substances Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DTSC Form 1430 by clicking the link below or browse more documents and templates provided by the California Department of Toxic Substances Control.

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Download DTSC Form 1430 "Certified Appliance Recycler Waste Management Certification" - California

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State of California – California Environmental Protection Agency
Department of Toxic Substances Control
DTSC 1430 Form - Certified Appliance Recycler Waste Management Certification
According to AB 2277 (2004), a Certified Appliance Recycler (CAR) must remove and properly manage ‘materials that
require special handling’ from discarded major appliances. (Health & Saf. Code §25211)
To document that the ‘materials that require special handling’ were removed from major appliances prior to the
appliance being crushed, baled, shredded, sawed, sheared apart or otherwise processed in a manner that could result
in the release of these materials; scrap metal recycling facilities receiving appliances that have had ‘materials that
require special handling’ removed, must collect DTSC 1430 form at the time of transaction. DTSC 1430 form is to be
completed by the CAR that removed the materials that require special handling, not by the transporter. DTSC 1430
form is a written certification signed by the CAR that ‘materials that require special handling’ have been removed from
the appliances listed below, in a manner that maintained compliance with subdivision (a) of section 25212 of the
Health and Safety Code.
CAR@dtsc.ca.gov
For appliance recycling information contact:
.
 
 
DTSC CAR Number:
1.
 
Please confirm CAR contact information, associated with above CAR #
 
Name:
Phone #
 
Address:
 
 
EPA Hazardous Waste Generator Identification Number:
2.
 
(To obtain an EPA ID # complete DTSC 1358 form)
 
List the number of appliances next to the correct type for this shipment:
3.
 
Air Conditioner:
Washer:
Microwave:
Dryer:
Space Heater:
Boiler:
Refrigerator:
Oven:
Water Heater:
Stove:
Furnace:
Freezer:
Trash Compactor:
Other:
(please specify)
List all facilities that the ‘materials that require special handling’ removed from the above listed appliances
4.
were sent to, or the facilities where the materials will be sent:
 
Type of material:
Facility information:
 
Please circle the appropriate
Materials have been sent to
or
Material will be sent to
 
Type of material:
 
Facility information:
 
Please circle the appropriate:
Materials have been sent to
or
Material will be sent to
 
Type of material:
 
Facility information:
 
Please circle the appropriate:
Materials have been sent to
or
Material will be sent to
 
 
 
           
Date
 
CAR Name / Signature
 
 
 
           
Date
 
Transporter (if not CAR) / Signature
 
 
           
Date
 
 
Signature of Person Accepting Shipment
 
DTSC 1430 (7/9/19)
Clear
Print
 
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
DTSC 1430 Form - Certified Appliance Recycler Waste Management Certification
According to AB 2277 (2004), a Certified Appliance Recycler (CAR) must remove and properly manage ‘materials that
require special handling’ from discarded major appliances. (Health & Saf. Code §25211)
To document that the ‘materials that require special handling’ were removed from major appliances prior to the
appliance being crushed, baled, shredded, sawed, sheared apart or otherwise processed in a manner that could result
in the release of these materials; scrap metal recycling facilities receiving appliances that have had ‘materials that
require special handling’ removed, must collect DTSC 1430 form at the time of transaction. DTSC 1430 form is to be
completed by the CAR that removed the materials that require special handling, not by the transporter. DTSC 1430
form is a written certification signed by the CAR that ‘materials that require special handling’ have been removed from
the appliances listed below, in a manner that maintained compliance with subdivision (a) of section 25212 of the
Health and Safety Code.
CAR@dtsc.ca.gov
For appliance recycling information contact:
.
 
 
DTSC CAR Number:
1.
 
Please confirm CAR contact information, associated with above CAR #
 
Name:
Phone #
 
Address:
 
 
EPA Hazardous Waste Generator Identification Number:
2.
 
(To obtain an EPA ID # complete DTSC 1358 form)
 
List the number of appliances next to the correct type for this shipment:
3.
 
Air Conditioner:
Washer:
Microwave:
Dryer:
Space Heater:
Boiler:
Refrigerator:
Oven:
Water Heater:
Stove:
Furnace:
Freezer:
Trash Compactor:
Other:
(please specify)
List all facilities that the ‘materials that require special handling’ removed from the above listed appliances
4.
were sent to, or the facilities where the materials will be sent:
 
Type of material:
Facility information:
 
Please circle the appropriate
Materials have been sent to
or
Material will be sent to
 
Type of material:
 
Facility information:
 
Please circle the appropriate:
Materials have been sent to
or
Material will be sent to
 
Type of material:
 
Facility information:
 
Please circle the appropriate:
Materials have been sent to
or
Material will be sent to
 
 
 
           
Date
 
CAR Name / Signature
 
 
 
           
Date
 
Transporter (if not CAR) / Signature
 
 
           
Date
 
 
Signature of Person Accepting Shipment
 
DTSC 1430 (7/9/19)