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4WDe artmenl of Toxic Substances Control <br /> Sldte of California—Callforn, \ronmental Protection Agency P <br /> rphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DISC by mailing to; <br /> Attn: Consumer Products SectionECEjv� <br /> Department of Toxic Substances Control LJ <br /> Office of Pollution Prevention and Green Technology <br /> 1001 "1" Street, 11th Floor 210.,, <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806TH <br /> Month: J01, Year: 7 <br /> Name of scrap recycling facility: (USI <br /> US��tU�� <br /> Facility address: <br /> Name of CAR: 0.51 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: <br /> Refrigerators: t Boilers: <br /> Freezers: Furnaces: <br /> Microwaves: Water Heaters: <br /> Washers: 1 Air conditioners: <br /> Dryers: Trash compacters: <br /> Ovens: <br /> Other (please specify): <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 Bischofherger <br /> Name �4.,E. Environmental Health&Safety <br /> M I(P. <br /> P4 71ANG 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:Pbischotberger@usrscrap.com <br /> www.usrscrap.com <br /> DTSC Form 1468(1/15/09) Page 1 of 1 <br />