Laserfiche WebLink
State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> Orphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DISC by mailing to: <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Cai�t <br /> Office of Pollution Prevention and Green �edhJ� y <br /> 1001 "1" Street, 11th Floor <br /> P.0, Box 806 iC v 2 0 2017 <br /> Sacramento, California 95812-0806 <br /> ENVIRONMENTAL HEALTH <br /> Month: 6C-lv&r Year: 20 / 9- pFPARTMENT <br /> Name of scrap recycling facility. <br /> Facility address: � � ' <br /> Name of CAR: 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: -$- stoves/nVetis 3" <br /> Refrigerators: 3 Boilers: -&- <br /> Freezers: -e- Furnaces: -&- <br /> Microwaves: l -5 G Water Heaters: �2 S<o <br /> Washers: .7- 03 Air conditioners: -e- <br /> Dryers: 2 - Trash compacters: -4�p- <br /> Ovens` ' <br /> Other (please specify): -Di S�w,aStia„r5: Pj <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 /> Universal Service Recycling, Inc. <br /> Paul Bischotberger <br /> Name _ Environmental Health&Safety <br /> C , 209•944•9555 <br /> FAX:209•944• 5552 <br /> CELL:209•855• 1715 ...... <br /> ............. ......... <br /> Contact Information 3200 South El Dorado Street,Stockton,CA 95206 <br /> E-mail: Pbischofberger«usrscrap.com <br /> www.usrscrap.com Pago 1 of 1 <br /> DT3C Form 1468(111!5109) <br />