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rState of California—Camornia 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 Sectionit' _.. <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology WG-0 7 2017 <br /> 1001 "1" Street, 11th Floor <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 ENVIRONMENTAL HEALTH <br /> r`PPAn-TMENT <br /> Month: JC) Year: 7 <br /> /UE, �5� i <br /> Name of scrap recycling facility: J� S CX;11c4e Ac A)CN <br /> Facility address: <br /> Name of CAR: U5F{ Sr t�E� CAR # 363 <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: s Boilers: <br /> Freezers: �_ Furnaces: <br /> Microwaves: Water Heaters: 6 <br /> Washers: O Air conditioners: <br /> Dryers: Z-Sb Trash compacters: <br /> Ovens/s 7-60S 23 8" <br /> Other (please specify): 1215J*eJAt%b'1!V, W' ' ( 7 <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 I§LK209 <br /> Environmental Health&Safety <br /> •944•9555 <br /> FAX: 209.944•5552 <br /> CELL: 209•855• 1715 <br /> Contact Information 3200 South EI Dorado Street,Stockton,CA 95206 <br /> E-mail Pbischotberger@usrscrap-com <br /> DTSC Form 1468(1/16/09) www.usrscrap.com <br /> Page 1 of 1 <br />