Please be advised that [Your Organization] intends to use the scrap metal exemption of 6NYCRR 371.1 (g)(1)(iii)('b') for its used computer monitors, keyboards, and central processing units that will be shipped from its facility, located at [Your Address] to Rochester Computer Recycling & Recovery, 7318 Victor Mendon Rd, Victor, NY 14564 where the items will be dismantled, with scrap metal pieces obtained during the dismantling routed to [on file with NYS Department of Environmental Conservation].

Please contact the either Rochester Computer Recycling & Recovery at 585-924-3840 or the undersigned at [Your Organization Phone Number] if you have any questions.

Sincerely,

<signed>
[Your Organization Representative name and title]

Mail completed notification form to DEC at this address: