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a <br /> State of California—California Environmental Protectlon Agency Department of Toxic Substanoes Control <br /> Orahan Appliance Monthly Rept Foal " E; Ea �. <br /> r <br /> Please send this document on a monthly basis to DTSC by mailing to: <br /> Attn: Consumer Products Section k i 7 201-1 <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green TechnolggyVIRONMENTAL HEALTH <br /> 1001 "I" Street, 11th Floor DEPARTMENT <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> Month:j%% Year: 2,0 / rE f�Ec yc zi p r A <br /> Name of scrap recycling facility: v/3�VEK6 567A� v�� <br /> �2.a O E Z. ,�70��p d 5 7 S�CIC`/�'A) ,� <br /> Facility address.. <br /> Name of CAR: (�N�t1 115520c41A)gCAR # --3063 <br /> fN (� <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 compactors: <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 /> ..... Paull Bischofberger <br /> Name ,y, Environmental Health&Safety <br /> µ s <br /> 209.944.9555 <br /> FAX:209.944•5552 <br /> CELL:209.855 1715 <br /> Contact Informs 3200 South EI Dorado Street,Stockton,CA 95206 <br /> E-mail: Pbischofberger@usrscrap.com <br /> DTSC Form 1468(Ilii www.usrscrap.coni Page 1 of 1 <br />