Form DTSC1493 "E-Waste Annual Report Form for Businesses With Many Collection Sites" - California

What Is Form DTSC1493?

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 May 1, 2011;
  • 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 DTSC1493 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 DTSC1493 "E-Waste Annual Report Form for Businesses With Many Collection Sites" - California

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State of California – California Environmental Protection Agency Department of Toxic Substances Control
E-waste Annual Report Form for Businesses with Many Collection Sites
Instructions: This Annual Report form is provided as a convenience for businesses that have facilities that collect e-waste, and cannot be used for any facilities
that treat e-waste. The DTSC facility ID number can be found in your online notification account. It is NOT your CEWID number. Please use additional sheets as
necessary. Please send completed forms to DTSC by certified mail, return receipt requested:
Dept. of Toxic Substances Control
Universal Waste Notification and Reporting Staff
P.O. Box 806
Sacramento, CA 95812-0806
ATTN: Universal Waste Handling Activities
General Business Information *
Business Name
Telephone #
Mailing address
Contact Person’s name
contact phone#
email (optional)
1. Check the types of electronic waste handled (received) for each collection site *
DTSC Facility
ID number
DTSC 1493 (01/05/2011)
Page 1 of 4
State of California – California Environmental Protection Agency Department of Toxic Substances Control
E-waste Annual Report Form for Businesses with Many Collection Sites
Instructions: This Annual Report form is provided as a convenience for businesses that have facilities that collect e-waste, and cannot be used for any facilities
that treat e-waste. The DTSC facility ID number can be found in your online notification account. It is NOT your CEWID number. Please use additional sheets as
necessary. Please send completed forms to DTSC by certified mail, return receipt requested:
Dept. of Toxic Substances Control
Universal Waste Notification and Reporting Staff
P.O. Box 806
Sacramento, CA 95812-0806
ATTN: Universal Waste Handling Activities
General Business Information *
Business Name
Telephone #
Mailing address
Contact Person’s name
contact phone#
email (optional)
1. Check the types of electronic waste handled (received) for each collection site *
DTSC Facility
ID number
DTSC 1493 (01/05/2011)
Page 1 of 4
State of California – California Environmental Protection Agency Department of Toxic Substances Control
1. continued
DTSC Facility
ID number
* If there are changes to your business or facility information (name, mailing address, contact person, telephone number) please record below:
DTSC 1493 (01/05/2011)
Page 2 of 4
State of California – California Environmental Protection Agency Department of Toxic Substances Control
2. Quantities handled (received) for each site (report either count or weight (for CRT devices and CRTs, include average weight of one unit))
CRT devices
Electronic devices
CRTs
CRT glass
DTSC Facility
count (units)
weight (lbs)
lbs/unit
count (units)
weight (lbs)
count (units)
weight (lbs)
lbs/unit
weight (lbs)
ID number
DTSC 1493 (01/05/2011)
Page 3 of 4
State of California – California Environmental Protection Agency Department of Toxic Substances Control
3. Destination and Respective Quantities (report either count or weight (for CRT devices and CRTs, include average weight of one unit)). Use
additional pages as necessary.
Destination Name
Address
City, State, Zip
Country
Phone number
CRT devices
Electronic devices
CRTs
CRT glass
count
weight
count
count
weight
weight
Facility ID:
(units)
(lbs)
lbs/unit
(units)
weight (lbs)
(units)
(lbs)
lbs/unit
(lbs)
DTSC 1493 (01/05/2011)
Page 4 of 4
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