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Stale of California—California Environmental protection Agency <br /> Department of Toxic Substances Control <br /> Orn an A Ilance Monthly Report or <br /> Please send this document on a monthly basis to DTSC by mailing to, <br /> Attn: Consumer Products Section R . F��E E <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology <br /> 1001 111" Street, 11th Floor <br /> P,o. Box 806 EWIRONMENTAL HEALTH <br /> j Sacramento, California 95812 0806 PERMIT/SERVIrES <br /> Month: Year: / 7s—67A v >F, <br /> Name of scrap recycling facility: v� VFe,6D9�- <br /> Facility address: 6 .3 <br /> Name of CAR: ()N/v�ER�`� <br /> Nam rti <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, <br /> but is appreciated: <br /> Space HeStoves: <br /> Refrigerators: Boilers: <br /> Freezers. Furnac <br /> es: <br /> Microwaves: Water Heaters: <br /> Washers: Air conditioners: <br /> Dryers: Trash compactors: <br /> Ovens: <br /> Other (please specify): <br /> The names and addresses of each person who <br /> hluded onot edfodelivered, or sold llowing add tional pagesn <br /> appliances to this scrap recycling facility Is inc <br /> This information has also been supmitted to my CUPA. <br /> Sincerely, <br /> Universal Service Recycling, Inc. <br /> ..... .. <br /> Paul Bi<schofberger <br /> ........ . <br /> Name Environmental Health&Safety <br /> ` 209.944.9555 <br /> f FAX:209•944•5552 <br /> CELL:209•855• 1715 <br /> Contact Informi 3200 South EI Dorado Street,Stockton,CA 95206 <br /> E-mail:Pbischofberger@usrscrap.com Paye 1 of 1 <br /> www.usrscrap.com <br /> DTSC Form 1468{1111 <br />