DTSC Form 1468 "Orphan Appliance Monthly Report Form" - California

What Is DTSC Form 1468?

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 10, 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 1468 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 1468 "Orphan Appliance Monthly Report Form" - California

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State of California – California Environmental Protection Agency
Department of Toxic Substances
 
Control
Orphan Appliance Monthly Report Form
Submit this report on a monthly basis to DTSC:
Department of Toxic Substances Control
Attn: HWMP – Orphan Appliance Report
th
1001 “I” Street, 11
Floor
P.O. Box 806
Sacramento, California 95812-0806
or
CAR@dtsc.ca.gov
Report Month:
Year:
Name of scrap recycling facility:
Facility address:
Name of CAR:
CAR #
Total number of “orphan” appliances received this month
(as indicated by use of
DTSC Form 1459 received)
The information in the table below is not required, but is appreciated:
Space Heaters:
Stoves:
Refrigerators:
Boilers:
Freezers:
Furnaces:
Microwaves:
Water Heaters:
Air conditioners:
Washers:
Dryers:
Trash compacters:
Other:
Ovens:
(please specify)
The names and addresses of each person who transported, delivered, or sold “orphan” appliances to
this scrap recycling facility is included on the following additional pages or the included DTSC 1459
forms. This information has also been submitted to my CUPA.
 
Name
Title
Contact Information
 
DTSC 1468 (7/10/19)
Print
Clear
State of California – California Environmental Protection Agency
Department of Toxic Substances
 
Control
Orphan Appliance Monthly Report Form
Submit this report on a monthly basis to DTSC:
Department of Toxic Substances Control
Attn: HWMP – Orphan Appliance Report
th
1001 “I” Street, 11
Floor
P.O. Box 806
Sacramento, California 95812-0806
or
CAR@dtsc.ca.gov
Report Month:
Year:
Name of scrap recycling facility:
Facility address:
Name of CAR:
CAR #
Total number of “orphan” appliances received this month
(as indicated by use of
DTSC Form 1459 received)
The information in the table below is not required, but is appreciated:
Space Heaters:
Stoves:
Refrigerators:
Boilers:
Freezers:
Furnaces:
Microwaves:
Water Heaters:
Air conditioners:
Washers:
Dryers:
Trash compacters:
Other:
Ovens:
(please specify)
The names and addresses of each person who transported, delivered, or sold “orphan” appliances to
this scrap recycling facility is included on the following additional pages or the included DTSC 1459
forms. This information has also been submitted to my CUPA.
 
Name
Title
Contact Information
 
DTSC 1468 (7/10/19)