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Ity. To: Training and Technical Support Section Bureau of Technical Support Division of Environmental Remediation New York State Department of Environmental Conservation 625 Broadway Albany, NY 12233-7020 Date: Generator facility name: Name and title of person filling out form Street Address: Generator phone number intends to use the scrap metal exemption of 6 NYCRR 371.1(g)(1)(iii)(b) for certain used computer monitors, peripherals, central processing units, or other used electronics item.

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