COLLECTION BUCKET REQUEST FORM CONVENIENCE SWITCH COLLECTION PROGRAM

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Through House Bill 2793, the Texas Legislature called for the creation of a voluntary convenience switch collection program in the state of Texas. The goal of this program is to remove convenience switches from underneath the hood and the trunk before a vehicle is c rushed and/ or shredded for recycling. If you would like to participate in this voluntary program, simply take a moment to complete this form.

Once you have complete d your Convenience Switch Collection Bucket request form, it can be returned to ELVS by mail at the address printed on the bottom of t his form. Section I: Please tell us about your business Approximately how many salvage vehicles are processed by your facility each month? Vehicle Recycler How would you classify your facility?

Scrap Metal Recycling Facility Vehicles manufactured prior to 2003 by the following companies may contain mercury convenience switches. Yes , my facility will typically process vehicles manufactured by these companies. I would like to receive a FREE convenience switch collection bucket for my facility!

(You can also request a collection bucket online at www.elvsolutions.org .) 1 Lincoln Audi Cadillac Chevrolet FordGMC Dodge Mazda Jeep OldsmobilePontiac Saab Saturn Chrysler MercuryVolvo Buick Eagle Plymouth To assist facilities ... more. less.

in collecting convenience switches removed from vehicles they have processed, the participating automobile manufacturers are providing collection buckets to participating facilities throughout Texas. Facilities that have not yet received a collect ion bucket can use this form to request a bucket and related materials from the End of Life Vehicle Solutions (ELVS) Corporation. Section II: How can we contact you? NAME OF COMPANY: PHYSICAL ADDRESS: CITY: ZIP CODE: MAILING ADDRESS (if different): STATE: DESIGNATED CONVENIENCE SWITCH COLLECTION PROGRAM CONTACT PERSON*: SALUTATION: Mrs. Ms. Mr. * This person will be your facility's primary contact person for coordinating any bucket deliveries or collections associated with the voluntary Convenience Switch Collection Program. TX CITY: ZIP CODE: STATE: Any questions regarding the voluntary Convenience Switch Collection Program can be directed to James Voelker with the TCEQ Pollution Prevention and Industry Assistance Section at jvoelker@tceq.state.tx.us . Convenience switches will only need to be removed from vehicles manufactured by the companies listed above. Does your facility typically process vehicles manufactured by these companies? 2 3 Mail your completed request form to ELVS at: End of Life Vehicle Solutions PO Box 3282 Farmington Hills, MI 48333-3282 COLLECTION BUCKET REQUEST FORM T E X A S C O M M I S S I O N O N E N V I R O N M E N T A L Q U A L I T Y CONVENIENCE SWITCH COLLECTION PROGRAM If you have questions on how to fill out this form or about the Convenience Switch Collection Program, please contact us at 512 /239-3100. Individuals are entitled to request and review their personal information that the agency gathers on its forms. They may also h ave any errors in their information corrected. To review such information, contact us at 512/239-3282. If you have questions on how to fill out this form or about the Convenience Switch Collection Program, please contact us at 512 /239-3100. TCEQ-20288a (06-02-2006) Print Form

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