Laserfiche WebLink
State of California—California En-- amental Protection Agency <br /> artment of Toxic Substances Control <br /> Orphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DTSC by mailinc :�� ���® <br /> Attn: Consumer Products Section �� ll <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology MAR 2 6 2018 <br /> 1001 "1" Street, 11 th Floor <br /> P.O. Box 806 ENVIRONMENTAL <br /> Sacramento, California 95812-0806 <br /> Month: �--71 Year: 2 o ) Y <br /> Name of scrap recycling facility: (if�v;d.G/5i4/ �,�,.,,.�� `ycl^'S, .fie• <br /> Facility address: 5 v `� . �V, 5¢ �Ao CUsj_a e-A q-5 3,S-1 <br /> Name of CAR: GlM�airel ,c Ae.,e1 f� �!✓�. CAR # ,3 6.3 <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: , Boilers: ' <br /> Freezers: Furnaces: <br /> Microwaves. Water Heaters: <br /> Washers: Air conditioners: <br /> Dryers: Trash compacters: <br /> Ovens: <br /> Other (please specify): C ' <br /> The 11,11-nes 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 /> Ll5 <br /> Name ....... ... .. <br /> Title <br /> Contact Information <br /> D SC Form 1468(1/15/09) <br /> Page 1 of 1 <br />