Laserfiche WebLink
State of California—California I >nmental Protection Agency <br /> Department of Toxic Substances Control <br /> Orphan Appliance Monthl Report Form <br /> Please send this document on a monthly basis to DTSC by mailingt � � <br /> Attn: Consumer Products Section SEC <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology MAR 2 6 2018 <br /> 1001 "1" Street, 11th Floor <br /> P.O. Box 806 ENVlI�ONNiENTAL <br /> -0806 1,�nART�AFNT <br /> Sacramento, California 95812 <br /> Month: Year: -I-o I , <br /> Name of scrap recycling facility: tlxAVX� ,411 syr <br /> e—y e-4, � -r- <br /> Facility address: ��/Ss 2�-/" �vr 57,4 C rA me,vA e CA <br /> �s �Zy <br /> Name of CAR: jl,v,•6,e1.PAf1 j rery /� -7Ne CAR # <br /> 3 <br /> Total number of"orphan" appliances received this month (as indicated by use of DTSC <br /> Form 1459) received: <br /> This information is not required, but is appreciated: <br /> Space HeStoves: <br /> Refrigerators: Boilers: <br /> Freezers: Furnaces: <br /> Microwaves: �- <br /> Water Heaters: 3 6 <br /> Washers: _� Air conditioners: <br /> Dryers: 3 <br /> Trash compacters: <br /> Ovens: J �— <br /> Other (please specify): s 0 <br /> The names and addresses of each person who transported, delivered, or sold "orphan" <br /> appliances to this scrap recycling facility is included on the following additional pages. <br /> This information has also been submitted to my CUPA. <br /> Sincerely, <br /> j� <br /> Name ........... S <br /> !E! A• -Qi' <br /> Title <br /> Contact Information •�....�....... <br /> DTSC Form 1468(1/15/09) <br /> Page 1 of 1 <br />