Treated Wood Waste Notification

Date:	mm/dd/yy
TWW Generator Name:
EPA ID Number:
Mailing Address
Mailing Address 1:
Mailing Address 2:
City:
State:
Zip Code:
TWW Contact Person
First Name:
Last Name:
Telephone:
TWW Activity
Street/Location 1:
Street/Location 2:
City:
State:
County:
Zip Code:
E-mail Address:
Date Exceeded 10,000 lbs.:	mm/dd/yy

By submitting this notification, I am indicating that I am a duly authorized representative of this Treated Wood Waste (TWW) Handler and that the TWW Handler has generated more than 10,000 pounds of TWW this calendar year.

A confirmation that DTSC has received your notification will be sent to the e-mail address entered.

If you have questions regarding the TWW Notification, please contact Matthew Mulinax at (916) 324-0064 or send an e-mail to tww_help@dtsc.ca.gov.