Laserfiche WebLink
State of California—California En, nental Protection Agency rtment of Toxic Substances Control <br /> Orphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DTSC by mailing <br /> Attn: Consumer Products Section RECEIVED <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology rLB 0 2018 <br /> 1001 "1"Street, 11 th Floor <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Month: Year: 2-0 ( -4- <br /> Name <br /> -4-Name of scrap recycling facility: S."o GL IRA e-ye—&vJ, SNe. <br /> Facility address: .5"-?-0 5 . -R'5+ 54-. Ivko cUSf-a, GA 95 3S1 <br /> Name of CAR: amwersw/ r,ctz Aegcl f, XWe. CAR # ,jro3 <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: 9' <br /> Refrigerators: d Boilers: <211 <br /> Freezers: Furnaces: <br /> Microwaves: Water Heaters: (7 <br /> Washers: g Air conditioners: � <br /> Dryers: 5 Trash compacters: <br /> i <br /> Ovens: <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 /> Name Title <br /> .69J sl...-..l�yl�......,3?0o...,S;. /, •.t.lo .s� o >�vv �s7-o� <br /> ... ..... <br /> Contact Information <br /> DTSC Form 1468(1/15/09) Page 1 of 1 <br />