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State of California—California Er ' Inmental Protection Agency <br /> partment of Toxic Substances Control <br /> . rPhan Appliance Monthly Renorr F.,..,, <br /> -- - .. <br /> Please send this document on a monthly basis to DTSC by mailing to: <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control �! ' <br /> Office of Pollution Prevention and Green Technology t E <br /> 100 1 "1"Street, 11 th Floor f,/r j <br /> P.O. Box 806 2018 <br /> Sacramento, California 95812-0806 <br /> '1DVMENTAL <br /> Month: _a Year: 2_0r <br /> °QRTMENT <br /> Name of scrap recycling facility: ��.t.�'✓,usa� yrY, e-ye- �rNc <br /> Facility address: b'y 5-s" 2�/�`i ,qv,, 5A c rA ry�e�v�, � CA <br /> Name of CAR: ttm-va/.ritj1 f&0.-i-,-e CAR # <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: <br /> Refrigerators: Boilers: Q� <br /> Freezers: Furnaces:: <br /> Microwaves: 5 Water Heaters: <br /> Washers: } 3 Air conditioners: <br /> Dryers: } a1 Trash compacters: <br /> 54Vti.'� Ovens: <br /> Other (please specify): -:5� <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 <br /> Title <br /> e el <br /> Contact Information .......... <br /> DTSC Form 1468(1/15/09) <br /> Page 1 of 1 <br />