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Mercury Certification for Vehicle Recyclers & Mobile Crushers

By Wesley Hayes,2014-07-01 11:28
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Mercury Certification for Vehicle Recyclers & Mobile Crushers

     Massachusetts Department of Environmental Protection 20 Bureau of Waste Prevention Calendar Year

     Mercury Certification for

     Vehicle Recyclers & Mobile Crushers MassDEP Facility ID#

    Filing Deadline: This form is due to MassDEP by March 1 following the calendar year for which you are certifying.

     A. Facility Information

    Important: When filling out Name forms on the computer, use only the tab key Street Address to move your cursor - do not use the return City/Town State Zip Code key.

    Contact Person Contact Telephone

    Contact Email Address

    Mailing Address (if different)

     Street Address/P.O. Box

     City/Town State Zip Code

     B. Applicability

     1. Are you a vehicle recycler that acquired and dismantled six or more vehicles for the primary

    purpose of reselling their parts or scrap metal during the year covered by this certification?

     Yes* No**

     2. Did you operate a mobile crushing unit that crushed vehicles at locations other than the address

    identified in Section A during the year covered by this certification?

     Yes* No**

     * If you answered YES to either of the ** If you answered NO to both questions above, sign

    questions above, you must complete the below, complete the fields beneath your signature,

    entire form. Skip to Section C. and return this page of the form to: MassDEP Vehicle Mercury Program One Winter Street, 6th Floor Boston, MA 02108

    Keep a copy of the completed form for your records.

    Signature

    Name

    Title

    Date (MM/DD/YYYY)

    hgvrcert• 2/08 Mercury Certification for Vehicle Recyclers & Mobile Crushers • Page 1 of 6

     Massachusetts Department of Environmental Protection 20 Bureau of Waste Prevention Calendar Year

     Mercury Certification for

     Vehicle Recyclers & Mobile Crushers MassDEP Facility ID# C. Resale of Mercury-Added Switches

    1. Did you sell or distribute any mercury-added switches, with the exception of switches incorporated

     in anti-lock braking systems or air bags, for new installation in motor vehicles during the year

    covered by this certification? [310 CMR 74.05 (2)]

     Yes Submit Return to Compliance Plan No

     D. Removal of Mercury-Added Components Before Crushing

     1. Were any vehicles crushed, partially crushed, or baled at your business during the year covered by

    this certification?

     Yes No Skip to Question 6

    2. If you answered YES to Question 1, and you operated a crushing unit at your business, were ALL

     required mercury-added components* removed before the vehicles were crushed during the year

    covered by this certification? [310 CMR 74.04 (1) and (2)]

     Yes No Submit Return to Compliance Plan

     Not Applicable: Vehicles were crushed by a mobile crushing firm.

    *Note: Required components include mercury-added vehicle switches and mercury high intensity discharge

    (HID) headlamps. Components that do not need to be removed are (1) those that are inaccessible due to

    significant damage in the area that contained the switch and (2) mercury-added lamps used to backlight the dashboard or electronics.

     3. Did you hire a mobile crushing firm during the year covered by this certification?

     Yes Provide Details: Company Name, Address & Phone Number

     No Not Applicable: My company is a mobile crushing firm. Skip to Question 6

     4. If you answered YES to question 3, did you remove ALL required mercury-added components?

    (See note above)

     Yes Skip to Question 6 No Answer Question 5

     5. If you answered NO to Question 4, did you inform the mobile crushing firm that it was their

    responsibility to remove the mercury-added components? [310 CMR 74.04 (1) and (2)]

     Yes No Submit Return to Compliance Plan

    6. If you provided mobile crushing services for other businesses during the year covered by this

     certification, were ALL required mercury-added components removed before crushing those

    vehicles? [310 CMR 74.04 (1) and (2)] (See note above)

     Yes No Submit Return to Compliance Plan

     Not Applicable: Did not provide mobile crushing services to other businesses during the certification year.

    Note: If you operate a mobile crushing unit, unless the vehicle owner has informed you that all mercury-added

    components have been removed, you must remove mercury-added components yourself before crushing.

    hgvrcert• 2/08 Mercury Certification for Vehicle Recyclers & Mobile Crushers • Page 2 of 6

     Massachusetts Department of Environmental Protection 20 Bureau of Waste Prevention Calendar Year

     Mercury Certification for

     Vehicle Recyclers & Mobile Crushers MassDEP Facility ID# D. Removal of Mercury-Added Components Before Crushing (continued)

     7. Other than crushing, partial crushing or baling, did you manage end-of-life vehicle bodies in any

    other way during the year covered by this certification? (Check more than one if applicable.)

     Yes Transported Uncrushed to Yes Other (Describe Below) No Skip to Section E

    Other Recycler/Scrap Recycler Answer Question 8

    Answer Question 8

     Description

     8. Did you remove mercury-added components before managing the end-of-life vehicle bodies in the

    manner described above?

     Yes No

     E. Certification to Scrap Recycling Facilities

     1. Did you sell or deliver any crushed, partially crushed, flattened or baled vehicle bodies to a scrap

    recycling facility in Massachusetts during the year covered by this certification?

     Yes Answer Question 2 No Skip to Section F

     2. If you answered YES to Question 1, did you certify in writing, for all crushed, flattened or baled

    vehicle bodies in each shipment sold or delivered to a scrap recycling facility, that all mercury- added vehicle switches were removed? [310 CMR 74.04(3)]

     Yes No Submit Return to Compliance Plan

     F. Management of Mercury-Added Components

     1.Were all containers used to store mercury-added switches and other mercury-added components

    that were removed from vehicles labeled in one of the following ways? [310 CMR 30.1034(4)(d)]

     ? Universal Waste: Mercury-Containing Devices

    ? Waste Mercury-Containing Devices ? Used Mercury-Containing Devices

     Yes No Submit Return to Compliance Plan

     Not Applicable: Did not remove any mercury-added components. Skip to Section G

     2. If you answered YES to Question 1, did you mark the date you started to store mercury-added

    switches and other mercury-added components on each container used? [310 CMR 30.1034(6)(c)]

     Yes No Submit Return to Compliance Plan

    3. If you answered YES to Question 1, once you started collecting mercury-added switches or other

     mercury-added components in a container, did you ship the container off-site within one year of the

    date on which you started storing the items? [310 CMR 30.1034(6)(b)]

     Yes Skip to Question 5 No Submit Return to Compliance Plan (Unless you were waiting until you had one full

     container)

    hgvrcert• 2/08 Mercury Certification for Vehicle Recyclers & Mobile Crushers • Page 3 of 6

     Massachusetts Department of Environmental Protection 20 Bureau of Waste Prevention Calendar Year

     Mercury Certification for

     Vehicle Recyclers & Mobile Crushers MassDEP Facility ID# F. Management of Mercury-Added Components (continued)

     4. If you answered YES to Question 1, did you send your container(s) of removed mercury-added

    switches or other mercury-added components to a facility licensed to handle mercury?

    [310 CMR 30.1037(1)]

     Yes, I sent my container(s) of mercury-added switches to EQ Industrial Services under the End of Life

    Vehicle Solutions (ELVS) program.

     Note: ELVS is the national vehicle switch recovery program funded by vehicle manufacturers, which has

    contracted with EQ Industrial Services, a hazardous waste management firm, for management of the returned

    switches.

     Yes, I sent my container(s) to the licensed hazardous waste or recycling firm identified below.

    Company Name

    Street Address

    City/Town State Zip Code

     No Submit Return to Compliance Plan

     5. How many switches did you send for recycling in the period covered by this certification?

     Number

     Note: Find the number of switches EQ Industrial Services has received from you at: http://www.eqonline.com

    Click ELVS Mercury Switch Recovery Program in the sidebar, then scroll down to Collection Reporting and

    enter both the certification year and Massachusetts before clicking on the Report button to view the State

    Report. Click the first letter of your business name and find your business, then click View Detail. Use the History section to estimate the number of switches recycled in your certification year.

     6. Was any mercury released at your facility (e.g., from a broken switch) during the period covered by

    this certification?

     Yes No Skip to Question 8

     7. If you answered YES to Question 6, did you manage these components in accordance with all

    applicable requirements of Massachusetts hazardous waste regulations? [310 CMR 30.1034(4)(c)]

     Yes No Submit Return to Compliance Plan

     8. Did you inform all of your employees who handle mercury-added components of proper handling

    and emergency procedures? [310 CMR 30.1035]

     Note: For requirements, see fact sheet at: http://www.mass.gov/dep/recycle/hazardous/autobiz.htm#mercury

     Yes No Submit Return to Compliance Plan

     G. Records Retention

     1. Does your business keep records supporting this certification, as required, for at least five (5) years

    or since the beginning of your first certification year (whichever is shorter)? [310 CMR 74.08]

     Yes No Submit Return to Compliance Plan hgvrcert• 2/08 Mercury Certification for Vehicle Recyclers & Mobile Crushers • Page 4 of 6

     Massachusetts Department of Environmental Protection 20 Bureau of Waste Prevention Calendar Year

     Mercury Certification for

     Vehicle Recyclers & Mobile Crushers MassDEP Facility ID# G. Records Retention (continued)

     2. Indicate which records you are keeping (check ALL that apply).

     Vehicle Recyclers:

     Records of shipments of mercury-added switches

     Printout(s) from EQ Industrial Services with your business’ specific switch count

     Contracts with or other notification to any mobile crusher you hired of the mobile crusher’s responsibility to

    remove mercury-added components from vehicles before crushing.

     Other Describe:

    Description

     Mobile Crushers:

     Contracts with or other documentation provided to vehicle recyclers that specify that they were responsible for removal of the mercury-added components.

     Records of shipments of mercury-added switches

     Printout(s) from EQ Industrial Services with your business’ specific switch count

     Other Describe:

    Description

     H. Releases of Oil or Hazardous Materials

     1. Did you have any reportable releases of oil or hazardous materials at this business, during the

    year covered by this certification?

    Search at http://public.dep.state.ma.us/MOMHL/HazMat.aspx for reportable quantities.

     Yes No

     2. If you answered YES to Question 1, list the date(s) of any incident(s).

    Date (MM/DD/YYYY) Date (MM/DD/YYYY)

    Date (MM/DD /YYYY) Date (MM/DD/YYYY)

    Date (MM/DD/YYYY) Date (MM/DD /YYYY)

    hgvrcert• 2/08 Mercury Certification for Vehicle Recyclers & Mobile Crushers • Page 5 of 6

     Massachusetts Department of Environmental Protection 20 Bureau of Waste Prevention Calendar Year

     Mercury Certification for

     Vehicle Recyclers & Mobile Crushers MassDEP Facility ID# I. Certification Statement

     I attest under pains and penalties of perjury: Authorized Signature I. That I have personally examined and am familiar with the information contained in this submittal, including any Printed Name and all documents accompanying this certification statement; Title

    II. That, based on my inquiry of those individuals responsible for obtaining the information, the information Date Signed (MM/DD/YYYY) contained in this submittal is, to the best of my knowledge, Source of Signatory Authority: true, accurate, and complete;

     III. That systems to maintain compliance are in place at If a Corporation: the business and will be maintained even if processes or operating procedures are changed; and President

IV. That I am fully authorized to make this attestation on Secretary behalf of this business. Treasurer I am aware that there are significant penalties, including,

    but not limited to, possible fines and imprisonment, for Vice President submitting false, inaccurate, incomplete or misleading information. Representative of the above (if authorized by corporate vote and if responsible for overall operation of the facility)

     If a Partnership:

     General Partner

    If a Sole Proprietorship:

     Proprietor

     KEEP A COPY OF THIS COMPLETED FORM AND THE RETURN TO COMPLIANCE FORM, IF

    REQUIRED, FOR YOUR FILES. MAIL THE ORIGINAL SIGNED FORM TO:

MassDEP

    Vehicle Mercury Program

    One Winter Street, 6th floor

    Boston, MA 02108

    hgvrcert• 2/08 Mercury Certification for Vehicle Recyclers & Mobile Crushers • Page 6 of 6

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