CIWS 198
Certificate of Destruction
Certificate of Recycling
Incoming Loads
Outgoing Containers
CIWS 198 - TV/Monitor Source Form
CIWS Form Notes:
All Tv's and Monitors Must from California, with a limit of 5 devices for Each Residential Address
Please use your Residential Address, or Business Address no PO boxes
CRT Devices (CRT TV/ CRT Monitors)
LCD Devices
(TV's and Monitors that have the following Technology: LCD, LED, Plasma, Laptops, All in !, or Flat Screen Devices with a Screen Size of 5 in )
Name
*
Street Address
*
Apartment, suite, etc
City
*
ZIP / Postal Code
*
Business Name if Applicable
Phone
*
Number of CRT Devices
Number of LCD Devices
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