DEALER AFFIDAVIT, Option A: in Store Redemption

DEALER AFFIDAVIT Option A: In Store Redemption

All of the following standards of redemption of beverage containers in the stated store of the stated dealer are being met:

(1) The dealer redeems all empty beverage containers labeled “California Cash Refund”, “CA Cash Refund”, “CA Redemption Value”, “California Redemption Value”, or “CA CRV”, during all hours the dealer is open for business.

(2) The dealer has posted a sign at all public entrances to the dealer's place of business, which states that: a) Beverage containers can be redeemed at all open cash registers; or b) Beverage containers can be redeemed at a designated location within the store.

(3) The dealer is delivering, or having delivered, all empty beverage containers redeemed from consumers to a certified recycling center or processor for recycling.

Name of Your Store: ______Your Store's Address:______City, State ZIP: ______

Telephone Number: (____)______

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signed this day______, 20____, in ______County, CA. (Month) (Day) (Year)

______(Signature)

______(Printed Name)

______(Title-Owner/Manager)

If you would like to receive dealer signs, To fax or mail, please send to: please write the number requested below: Fax: (916) 552-4949 English______CalRecycle Convenience Zone Unit 801 K St, MS 17-01 Sacramento, CA 95814 Dealer ID Number: ______