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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> grphiin Apollance Mo t l mortFo <br /> tt E <br /> Please send this document on a monthly basis to DISC <br /> Attn: Consumer Products Section qPM 17 2017 <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology <br /> 1001 "1" Street, 11th Floor ENVIRONMENTAL HEALTH <br /> P.O. Box 606 DEPARTMENT <br /> Sacramento, California 95812-0808 <br /> Month: � Year: ;;2,0 7 �G Ec yc tip <br /> Name of scrap recycling facility: v <br /> Facility address. <br /> a O <br /> Name of CAR: UN/VE�QSSFR1/1G f5Cyc4"A)gCAR # �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 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 /> Paul Bischotberger ............. <br /> Name ,y, , Environmental Health&Safcty <br /> ry <br /> 209•944•9555 <br /> FAX:209.944.5552 <br /> CELL:209•855• 1715 <br /> Contact Inform, 3200 South El Dorado Street,Stockton,CA 95206 <br /> E-mail: Pbischofberger@usrscrap.com <br /> DT8C Form 1468(1/111 www.usrscrap.com Page 1 of 1 <br />