APPLICATION TO BE AN APPROVED CONSOLIDATOR …

                    APPLICATION TO BE AN APPROVED CONSOLIDATOR
             FOR HOUSEHOLD TELEVISIONS AND COMPUTER MONITORS IN MAINE

Use this form to request approval to perform consolidation facility services as described in Chapter 415,
Reasonable Costs for the Handling and Recycling of Electronic Wastes and 38 MRSA Section 1610. Attach
additional pages to provide all requested information.

PLEASE TYPE OR PRINT

Company Name: ___________________________                   Contact person:________________________________
Mailing Address: ____________________________               Telephone: ______________ Fax:_______________
Street Address: ______________________________              E-mail address: _______________________________
Town: ____________________________________                  State: ___      Zip: _________

                                    SIGNATURE OF APPLICANT
I certify under penalty of law that I have personally examined the information submitted in this document and
all attachments thereto and that, based on my inquiry of those individuals immediately responsible for obtaining
the information, I believe the information is true, accurate, and complete. I, the property owner or lessee,
authorize the Department to enter the property that is the subject of this application, at reasonable hours,
including buildings, structures or conveyances on the property, to determine the accuracy of any information
provided herein. I am aware there are significant penalties for submitting false information, including the
possibility of fine and imprisonment.

SIGNATURE:          ___________ _________________________ DATE:                     ________________________

PRINTED NAME: ____________________________________                       TITLE:     _____________________

                                              INSTRUCTIONS
1. Please refer to Chapter 415, Reasonable Costs for the Handling and Recycling of Electronic Wastes and Chapter
   850, section 3.A.13, the Universal Waste Handling provisions, of Maine's Hazardous Waste Management
   Regulations to understand the standards and operational requirements for consolidators operating within
   Maine's household e-waste handling and recycling system. If you have any questions that arise at any point
   during the application or review process, please contact Carole Cifrino at 207-287-7720.
2. Provide all required information. This application is due October 1, 2008. All consolidators will be approved no later
   that December 1, 2008 to provide services in calendar year 2009. INCOMPLETE APPLICATIONS WILL BE
   RETURNED.
    Submit your application to:         E-Waste Program
                                        Maine Department of Environmental Protection
                                        17 State House Station
                                        Augusta, Maine 04333
3. Keep a copy of the completed application for your files. This copy will be helpful in speeding up communications
   with the DEP staff if any questions arise during the review of the project.
                                        REQUIRED INFORMATION

1. Description. Attach a description of the company's qualifications and experience in managing electronic
   waste and universal waste, specifically including cathode ray tubes. Provide the physical addresses of all
   your facilities to be used in managing e-waste from Maine households. Include information on whether
   facilities are ISO 14001 and/or 18001 certified.

2. Financial capacity. Submit evidence that affirmatively demonstrates your financial solvency and financial
   ability to undertake consolidation of televisions and computer monitors in a manner consistent with Chapter
   415. This should include evidence that funds are or will be available for operations for a minimum of one
   year, as shown through the most recent corporate annual report indicating availability of sufficient funds to
   finance the proposed project through self-financing, together with explanatory material interpreting the
   report. If the applicant is a governmental entity, evidence that the entity has the bonding or other capacity
   to finance the operations of the facility. Include the company's balance sheets and income statements for
   the past 2 years, the number of employees, and the number of years in business. The Department may
   accept alternative documentation to demonstrate financial solvency, such as a bank letter of solvency in lieu
   of the balance sheets and income statements.

3. Technical ability. Include evidence that affirmatively demonstrates that the applicant has the technical
   ability to operate as a consolidator of televisions and computer monitors in Maine in accordance with
   Maine's E-Waste Law, 38 MRSA §1610. This information should include the applicant's or operator's prior
   experience and appropriate training related to handling of Universal Waste and/or hazardous waste. It must
   also include a description of the data management systems that will be used to meet the data tracking and
   billing requirements of Chapter 415. Include information on any relevant experience and training, such as
   training offered by IAER, completed by key personnel responsible for implementing this program for your
   company.

4. Disclosure statements.
   (a) Include a listing and explanation of any adjudicated civil violations and criminal convictions of, and
       administrative agreements or consent decrees or administrative orders, for violations of state or federal
       laws in the last five years.
   (b) Include a description and disclosure of all business relationships with electronic waste recycling and
       dismantling facilities and electronics manufacturers, including ownership of any electronic waste
       recycling and dismantling facilities or related companies, exclusive of any contractual relationships
       entered into to meet the requirements of Chapter 415.

5. Waste handling information. Please submit a description of the facility's waste handling systems. This
   must include:

   (a) a copy of the standard operating procedures for handling of televisions and computer monitors,
       including:
       (1) procedures for handling electronic waste in conformance with the requirements of 06-096 CMR
           850.3(A)(13).
       (2) procedures to track units that are identified at receipt as generated from a household in Maine, and
       (3) procedures for identifying and tracking the brand, waste type, unit weight and unit count of each
           eligible unit, including a sample of the written log that identifies responsible manufacturers by
           recording the brand and weight of each waste computer monitor and waste television delivered to the
           consolidation facility and identified at receipt as generated by a household in Maine;
       (4) procedures for managing wastes in conformance with the 3 required consolidator handling options
           that must be offered to manufacturers in accordance with Chapter 415, section 3.A.



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        (5) procedures for ensuring that manufacturers are not charged any costs for any unit received as part of
            the Maine household program that is sent for refurbishment.

   (b) A description of consolidation capacity, including the location and description of consolidation facilities
       and geographic service area(s).

   (c) Describe how you manage your waste streams. List all waste materials and disposal routes (e.g., which
       wastes go to landfill, incineration, reclaim, etc.?)

   (d) A listing of qualified recycling and dismantling facilities to which televisions and computer monitors
       may be shipped, including company name, location, contact person and contact information. Also, a
       copy of the sworn certification provided to you from the qualified recycling and dismantling facility that
       it meets Maine's Environmentally Sound Management Guidelines for the Recycling of Televisions and
       Computer Monitors. The ESM Guidelines and certification form are available on line at:
       http://www.maine.gov/dep/rwm/recycle/tvcomputerguidelines.htm.

   6. Fee schedule. Include a fee schedule for the next calendar year of total costs related to the handling,
      transportation and recycling of televisions and computer monitors, expressed as the price per pound for
      each of the following by geographic service area: transportation of 16,000 pounds from the municipal
      collection site(s) to the consolidator's handling facility, handling (unit weight and brand identification
      recording and tracking, recordkeeping, and accounting, plus storage for Option 1 manufacturers'
      product) at the consolidator's handling facility; transportation of 16,000 pounds of covered electronic
      devices to the recycling facility; and recycling. The total price [Transportation Part 1 + Consolidator
      Handling (Option 1 or all other) + Transportation Part 2 + Recycling] may not exceed $0.48 per pound.

        Submit your information in the following table format:

                             Geographic           Region 1          Region 2         Region 3        Region 4
                            Service area
         Transportation Part 1 - to
         consolidator's handling facility
         Consolidator handling
           ­Option 1 manufacturers
         Consolidator handling
          ­ all other manufacturers
         Transportation Part 2 - from
         consolidator's handling facility
         to recycling
         Recycling

        "Geographic service area" means four geographic areas of Maine delineated as: Region 1 - Aroostook,
        Washington, and Hancock Counties; Region 2 ­ Piscataquis and Penobscot Counties; Region 3 ­
        Sagadahoc, Kennebec, Somerset Waldo, Knox and Lincoln Counties; and Region 4 - Franklin Oxford,
        Cumberland, Androscoggin and York Counties.
        Please mark N/A if you do not plan to offer service in a specific region

        The Department's decision on this application is based in part on the applicant having costs competitive
        with other applicants.



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        Additional services offered to manufacturers: Please check all of the following services that you
          offer to manufacturers, and the cost for these services. This information does not affect your
          eligibility for approval; you may change these costs as needed at any time.

        ____ Serial numbers $___________

        ____ Screen size $__________

        ____ Part/model name or number $___________

        ____ Other (describe) _____________________________________              $____________


7. Insurance. Include evidence of commercial general liability insurance or equivalent corporate guarantee for
    accidents and other emergencies with limits of not less than $1,000,000 per occurrence and $1,000,000
    aggregate.


                                                     END




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