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._..._-.__...__.__.............. <br /> �. <br /> State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> ee `` Orphan Appliance Monthly Report Form <br /> RECEIEL) <br /> Please send this document on a monthly basis to DTSC by mailing to: <br /> APR 7 201! Attn: Consumer Products Section <br /> Department of Toxic Substances Control <br /> I`+WR;)N kNTALW—ALTH Office of Pollution Prevention and Green Technology <br /> PEMIT/SWIACES 1001 "1" Street, 11th Floor <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> Month: 14 �IZPV Year: W1WCW <br /> V/G� IQ�cYGL/ 6j <br /> Name of scrap recycling facility: <br /> Facility address: 'y✓ �' Tot �C <br /> �QG <br /> Name of CAR: 0,59, CAR # �{,Z <br /> Total number of"orphan" appliances received this month (as indicated by use of DTSC <br /> Form 1459) received.- <br /> This <br /> eceived:This information is not required, but is appreciated: <br /> Space Heaters: Stoves: <br /> Refrigerators: Boilers: <br /> Freezers: Furnaces: <br /> Microwaves: C:: <br /> Water Heaters: <br /> — <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 /> ...I....................•.. Paul Bischofberger <br /> Name ry i Environmental Health&Safety <br /> 209•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: Pbischofberger4usrscrap.com <br /> DTSC Form 1468(1115109) www.usrscrap.com Pape 1 of 1 <br />