Laserfiche WebLink
State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> _Orphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DTSC by mailing to: <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control RECEIVED <br /> Office of Pollution Prevention and Green Technology <br /> 1001 "1" Street, 11th Floor APR 1 7 2017 <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> ENVIRONMENTAL HEALTH <br /> Month: y Year: moo/ T DEPARTMENT <br /> Name of scrap recycling facility: AEe_Xe_(_1& 1 IAJC, <br /> Facility address: .s?d S' P` <br /> Name of CAR: Vsl� jovaFsm CAR # _gg3 <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): <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 uv Environmental Health&safety <br /> 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: Pbischofberger(tPusrscrap.corn <br /> DTSC Form 1488(1/15/09) Www.usrscrap.corn <br /> Page 1 of 1 <br />