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r <br /> State of Callfomla—Californl. En ronmental Protection Agency Department of Toxic Substances Control <br /> ;r han Appliance Monthly Report Form IV ED <br /> Please send this document on a monthly basis to DTSC by J Ril 4u <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control OCT 16 2017 <br /> Office of Pollution Prevention and Green Technology <br /> 1001 "1" Street, 11th Floor <br /> P.O. Box 806 ENVIRONMENTAL HEALTH <br /> Sacramento, California 95812-0806 DEPAPTMENT <br /> Month: Year: 2 <br /> Name of scrap recycling facility: UNi � �AjC� <br /> Facility address: s <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: r <br /> Refrigerators: Boilers: — <br /> Freezers: _--- Furnaces: <br /> Microwaves: Water Heaters: <br /> Washers: Air conditioners: 1 O <br /> Dryers: Trash compacters: �-- <br /> Ovens: �- <br /> Other(please specify): ,015WLJ may, <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 /> ......,...I..................... Paul Bischofberger <br /> Name 4iIVR : .. Environmental Health&Safety <br /> R 1 6 <br /> 209.944.9555 <br /> FAX:209.944.5552 <br /> CELL:209-855- 1715 <br /> Contact Information 3200 South El Dorado Street,Stockton,CA 95206 <br /> E-mail:Pbischofberger@usrscrap.com <br /> www.usrscrap.com <br /> DTSC Form 1468(1/18109) Page 1 at 1 <br />