DTSC Form 1478 "Notification for Exporting Electronic Waste" - California

What Is DTSC Form 1478?

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 June 29, 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;
  • Fill out the form in our online filing application.

Download a printable version of DTSC Form 1478 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 1478 "Notification for Exporting Electronic Waste" - California

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State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Notification for Exporting Electronic Waste
Instructions
This notification must be submitted to DTSC and your CUPA at least 60 days prior to the initial
export of electronic devices, CRTs, or CRT glass to be in compliance with 22 CCR Section
66273.40.
Completion of this notification is valid for the facility addresses indicated in this document, and
expires one year after the shipment “begin date”.
You must keep all export related documents, including a copy of this notification, for three years
from the first shipment date.
You must also comply with the reporting requirements of the California Public Resource Code
Section 42476.5 if you export covered electronic wastes (CRT devices; CRTs; LCD desktop
monitors, TVs, and laptops; portable DVD players with LCD screens; or some plasma TVs)
I. HANDLER INFORMATION
Business Name ______________________________________________________________________
Mailing Address ______________________________________________________________________
Street
City
State
Zip
Facility address, if different than mailing address_____________________________________________
Street address
___________________________________________________________________________________
City
State
Zip
Phone number _________________ 9 digit CA or EPA ID number (if applicable) ___________________
II. FOREIGN DESTINATION INFORMATION FOR THE MATERIALS EXPORTED
Primary Destination
Business Name ______________________________________________________________________
Address ____________________________________________________________________________
Street
City
State
Zip
Country ____________________________________________________________________________
All points of entry to and departure from each foreign country through which the materials will pass en
route: __________ to __________ to __________ to __________ to __________
________________________________________________________________________________
Description of recycling process for electronic devices, CRTs, and/or CRT glass if the foreign destination
will recycle these items:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
DTSC Form 1478 (06/29/10)
1 of 3
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Notification for Exporting Electronic Waste
Instructions
This notification must be submitted to DTSC and your CUPA at least 60 days prior to the initial
export of electronic devices, CRTs, or CRT glass to be in compliance with 22 CCR Section
66273.40.
Completion of this notification is valid for the facility addresses indicated in this document, and
expires one year after the shipment “begin date”.
You must keep all export related documents, including a copy of this notification, for three years
from the first shipment date.
You must also comply with the reporting requirements of the California Public Resource Code
Section 42476.5 if you export covered electronic wastes (CRT devices; CRTs; LCD desktop
monitors, TVs, and laptops; portable DVD players with LCD screens; or some plasma TVs)
I. HANDLER INFORMATION
Business Name ______________________________________________________________________
Mailing Address ______________________________________________________________________
Street
City
State
Zip
Facility address, if different than mailing address_____________________________________________
Street address
___________________________________________________________________________________
City
State
Zip
Phone number _________________ 9 digit CA or EPA ID number (if applicable) ___________________
II. FOREIGN DESTINATION INFORMATION FOR THE MATERIALS EXPORTED
Primary Destination
Business Name ______________________________________________________________________
Address ____________________________________________________________________________
Street
City
State
Zip
Country ____________________________________________________________________________
All points of entry to and departure from each foreign country through which the materials will pass en
route: __________ to __________ to __________ to __________ to __________
________________________________________________________________________________
Description of recycling process for electronic devices, CRTs, and/or CRT glass if the foreign destination
will recycle these items:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
DTSC Form 1478 (06/29/10)
1 of 3
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Alternate Destination for materials exported
Business Name ______________________________________________________________________
Address ____________________________________________________________________________
Street
City
State
Zip
Country ____________________________________________________________________________
Alternate Destination for materials exported
Business Name ______________________________________________________________________
Address ____________________________________________________________________________
Street
City
State
Zip
Country ____________________________________________________________________________
III. SHIPMENT INFORMATION
Duration of shipments to foreign destination:
Notification date: __________
Shipment “begin date” (must be at least 60 days after “notification date”): __________
Shipment “end date” (must not exceed 12 months after shipment “begin date”): __________
Types of materials sent to foreign destination:
Will you export any of the following?
Intact Cathode ray tubes (CRTs) (with yokes attached)
No
Yes
CRT containing devices (including monitors and TVs)
No
Yes
LCD desktop monitors or TVs
No
Yes
laptops or portable DVD players with LCD screens
No
Yes
plasma TVs (excluding plasma projection televisions)
No
Yes
If yes for any above listed materials, you must also submit the following documentation demonstrating
the following at least 60 days prior to exporting (California Public Resource Code Section 42476.5):
• the waste or device is being exported for the purposes of recycling or disposal
• the importation of the waste or device is not prohibited by an applicable law in the state or country
of destination and that any import will be conducted in accordance with all applicable laws
• the exportation of the waste or device is conducted in accordance with applicable United States
or applicable international law
• the waste or device will be managed within the country of destination only at facilities whose
operations meet or exceed the binding decisions and implementing guidelines of the Organization
for Economic Cooperation and Development for the environmentally sound management of the
waste or device being exported.
For additional information, see our
Q & A document on exporting Covered Electronic Devices”
DTSC Form 1478 (06/29/10)
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State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Estimated rate at which the materials will be exported (Example: 50,000 lbs per month)
Quantity
pounds/units Frequency of shipment
Electronic Devices
__________
__________
__________
1
CRTs
__________
__________
__________
1,2
CRT Glass
__________
__________
__________
1
For used CRTs and unprocessed CRT glass, a copy of your notification to US EPA [40 CFR
261.39(a)(5)(i)], and a copy of US EPA Acknowledgement of Consent [40 CFR 261.39(a)(5)(iv)] must
also be submitted if you will be exporting used CRTs for reclamation [22 CCR §62673.40(a)(4)(B)7
and §62673.40(b)]. A copy of the one time notification to US EPA (40 CFR 261.41) must be submitted
for used CRTs exported for reuse [22 CCR §62673.40(a)(4)(B)8].
2
For processed CRT glass, include the following information for the lead smelter/CRT glass furnace:
Business Name _______________________________________________________________
Address _____________________________________________________________________
Street
City
State
Zip
Country ______________________________________________________________________
Estimated total quantity that will be exported to the destination
Count
OR Weight (pounds)
Electronic Devices
__________ OR __________
CRTs
__________ OR __________
CRT Glass
__________
Mode of transportation
Volume of shipment (the estimated
(check all that apply)
Types of container
volume of one full, large shipping
3
(check all that apply)
container (40 ft x 8.5 ft x 8 ft) is 2720 ft
)
Truck
Gaylord container
Rail
Electronic Devices _______________
Shipping container
Air
CRTs
_______________
Other:
Ship
CRT Glass
_______________
_______________
IV. Certification
Universal Waste handler name:
Signature:
.
Notifications must be submitted to DTSC by certified mail, return receipt request.
Department of Toxic Substances Control
Universal Waste Notification and Reporting Staff
Attention: Notification to Export Electronic Devices, CRTs, and/or CRT glass
P.O. Box 806
Sacramento, CA 95812-0806
DTSC Form 1478 (06/29/10)
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