Form 1468 "Orphan Appliance Monthly Report Form" - California

What Is 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 January 15, 2009;
  • 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 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 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
Please send this document on a monthly basis to DTSC by mailing to:
Attn: Consumer Products Section
Department of Toxic Substances Control
Office of Pollution Prevention and Green Technology
1001 “I” Street, 11th Floor
P.O. Box 806
Sacramento, California 95812-0806
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:
This information is not required, but is appreciated:
Space Heaters:
Stoves:
Refrigerators:
Boilers:
Freezers:
Furnaces:
Microwaves:
Water Heaters:
Washers:
Air conditioners:
Dryers:
Trash compacters:
Ovens:
Other (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.
This information has also been submitted to my CUPA.
Sincerely,
…………………………………………
……………………………..
Name
Title
…………………………………………………………………………………………
Contact Information
DTSC Form 1468 (1/15/09)
Page 1 of 1
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
Orphan Appliance Monthly Report Form
Please send this document on a monthly basis to DTSC by mailing to:
Attn: Consumer Products Section
Department of Toxic Substances Control
Office of Pollution Prevention and Green Technology
1001 “I” Street, 11th Floor
P.O. Box 806
Sacramento, California 95812-0806
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:
This information is not required, but is appreciated:
Space Heaters:
Stoves:
Refrigerators:
Boilers:
Freezers:
Furnaces:
Microwaves:
Water Heaters:
Washers:
Air conditioners:
Dryers:
Trash compacters:
Ovens:
Other (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.
This information has also been submitted to my CUPA.
Sincerely,
…………………………………………
……………………………..
Name
Title
…………………………………………………………………………………………
Contact Information
DTSC Form 1468 (1/15/09)
Page 1 of 1