Form DTSC1388 "Notice of Intent to Handle and/or Treat or Recycle Electronic Devices, Cathode Ray Tubes (Crts) and/or Crt Glass" - California

What Is Form DTSC1388?

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 April 1, 2010;
  • 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;

Download a printable version of Form DTSC1388 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 Form DTSC1388 "Notice of Intent to Handle and/or Treat or Recycle Electronic Devices, Cathode Ray Tubes (Crts) and/or Crt Glass" - California

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State 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)
Page 1 of 4
State 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)
Page 1 of 4
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Additional handling/collection events:
Physical address, city, state, zip: _____________________________________________________________________
County: __________________________
EPA/ State ID Number (if applicable): ___________________________
Facility Owner Name ______________________________________________ Phone (____) __________________
Are there any changes from activity indicated in Section C? _____________________________________________
___________________________________________________________________________________________
Physical address, city, state, zip: _____________________________________________________________________
County: __________________________
EPA/ State ID Number (if applicable): _______________________________
Facility Owner Name ______________________________________________ Phone (____) __________________
Are there any changes from activity indicated in Section C? _____________________________________________
___________________________________________________________________________________________
Physical address, city, state, zip: _____________________________________________________________________
County: __________________________
EPA/ State ID Number (if applicable): _______________________________
Facility Owner Name ______________________________________________ Phone (____) __________________
Are there any changes from activity indicated in Section C? _____________________________________________
___________________________________________________________________________________________
Section C. Proposed Activities [22 CCR § 66273.32(c). 66273.74(a)(1)(g)] (Handlers and Recyclers)
Materials to Be Handled (Check all applicable boxes):
bare CRTs
CRT glass
CRT devices
Laptops with LCD monitors
LCD monitors
portable DVD players with LCD monitors
plasma televisions
LCD televisions
microwaves
VCRs
computers
printers
cellphones
telephones
radios
small consumer electronics
large consumer electronics
Source of materials (Check all applicable boxes):
Businesses
Households
Government agencies
Other handlers
Other __________
Could you accumulate 5,000 kg/11,000 lbs or more of universal waste at one time?
Yes
No
Section D. Handler Certification (optional):
The information in this form is, to be the best of my knowledge, true, accurate, and complete.
Name of report preparer
Signature of report preparer
Date
DTSC 1388 (04/01/10)
Page 2 of 4
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Section E. Treatment [22 CCR § 66273.74(a)] (Recyclers only)
Materials to Be Treated (Check all applicable boxes)
bare CRTs
CRT glass
CRT devices
Laptops with LCD monitors
LCD monitors
portable DVD players with LCD monitors
plasma televisions
LCD televisions
microwaves
VCRs
computers
printers
cellphones
telephones
radios
residual printed circuit boards
small consumer electronics
large consumer electronics
Check the box(es) that best describes your treatment/recycling activities.
Recycler Type I [22 CCR § 66273.72(c)]
Dismantling electronic devices (including CRT devices) into only their respective components using manual
methods, hand tools or mechanical separation of parts only. Treatment residuals are components of the electronic
device (e.g., circuit boards, integrated circuits, metals, plastic, wiring, universal waste batteries and lamps, etc.).
Removing yokes from CRTs without breaking glass.
Perform size reduction activities (e.g., crushing, compacting) on electronic devices without producing hazardous
waste residuals
Perform physical separation on electronic devices based on properties such as size, color, density, or
ferromagnetism without producing hazardous waste residuals
Recycler Type II [22 CCR § 66273.72(a)(2)(A) and § 66273.72(b)(1)]
Electronic devices and/or residual printed circuit boards that are not scrap metal and do not qualify for management
as universal waste produce hazardous waste residuals because of any of the following treatment methods (22 CCR §
66273.73 (c)):
physical size reduction activities such as cutting, breaking, shredding, crushing
physical separation based on properties such as size, color, density, or ferromagnetism
sampling/ashing and ball-milling of samples of electronic devices and/or treatment residuals
CRT and/pr CRT glass treatment including any of the following methods (22 CCR § 66273.73(c)):
Breaking CRT glass
Physical size reduction activities such as cutting, breaking, shredding, crushing
The use of pinpoint torch or hot wire to separate panel from funnel
Other (e.g., manufacture glass) please specify _______________________________________________________
Recycler types I or II who are not the property owner of the treatment facility must notify the property
owner that hazardous waste treatment will be performed at the facility [22 CCR § 66273.74(a)]
I have attached documentation demonstrating that I, the universal waste handler, have notified the property owner
that I am conducting hazardous waste treatment at the facility pursuant 22 CCR Chapter 23.
I, the universal waste handler, am the property owner of the facility specified in Section “A”.
DTSC 1388 (04/01/10)
Page 3 of 4
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
All treatment facilities (Recycler Type I or II) are subject to inspection
I, the universal waste handler, am aware that the facility specified in Section “A” is subject to unannounced
inspections by state or local agencies to verify compliance with applicable universal waste regulations, air laws, worker
health and safety laws, local zoning requirements and seismic and precipitation design standard requirements.
Type II Recyclers must provide additional documentation
Closure Plan [22 CCR § 66273.76(a)]
Cost estimate for closure [22 CCR § 66273.76(b)]
Financial responsibility for liability [22 CCR § 66273.76(c)]
Financial Assurance for closure [22 CCR § 66273.76(d)]
Section F. Certification
Recyclers:
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to be the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations. [22 CCR § 66273.74(d) and 66270.11(d)]
_____________________________________
___________________
Print Name
Title
_____________________________________
___________________
Original Signature (non-black ink)
Date
Section I. Hardcopy notifications and any supplemental information must be submitted to DTSC by certified mail,
return receipt request.
MAIL TO: Department of Toxic Substances Control
Universal Waste Notification and Reporting Staff
P.O. BOX 806
Sacramento, CA 95812-0806
Attention: Universal Waste Handling Activities
DTSC 1388 (04/01/10)
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