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State of California—California Em -iental Protection Agency [ tment of Toxic Substances Control <br /> RECEIVED Orphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DTSC by mailing to: <br /> Attn: Consumer Products Section <br /> FEB 0 5 2018 Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology <br /> FN VIRONNIENTAL IIEALTII 1001 "1" Street, 11th Floor <br /> k RT;N1 ENT P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> Month: Year: okv J <br /> Name of scrap recycling facility: tlAAvw,s,4� ivc, <br /> Facility address: f 4/Ss 2'-/A AV4 5-A c rA itnlw-/v , CA '757 97 <br /> Name of CAR: (,l,v;va/tire 12e 6,4,04wj, .Pve. CAR # 3 �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 Heaters: Stoves: I q 3 <br /> Refrigerators: 3 - Boilers: LA <br /> Freezers: Furnaces: 3 <br /> Microwaves: Water Heaters: 0 2— <br /> Washers: tA 0 3 Air conditioners: <br /> Dryers: 3 Trash compacters: <br /> Ovens: L <br /> Other (please specify): <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 /> ...... .ti!�-!-.. . ' ........... !.f ....1/�!.!viQ <br /> Name Title <br /> .......32.. ... :..Q.C�orAae .r7 � �s2oG <br /> Contact Information <br /> DTSC Form 1468(1/15/09) Page 1 of 1 <br />