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State of California—California Environmental Protection Agency Department of Toxic Substances Control <br /> Oriphan Appliance Monthly Report Form <br /> Please send this document on a monthly basis to DTSC b E E N E D <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control APR 2 1 2017 <br /> Office of Pollution Prevention and Green Technology <br /> 1001 T' Street, 11th Floor <br /> P.O. Box 806 ENVIRONMENTAL HEALTH <br /> Sacramento, California 95812-0806 DEPARTMENT <br /> Month: ���. Year: �2D/ <br /> , C. <br /> Name of scrap recycling facility: A/U FX5 pfc .JrX cyt=4.'l A) <br /> Facility address: 8ryss- 2y �.67 I / S�c� • <br /> Name of CAR: USi� CAR # 363 <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: 13 Boilers: I <br /> Freezers: Furnaces: -21 <br /> Microwaves: Water Heaters: 7 <br /> Washers: ,20 Air conditioners: <br /> Dryers: S$ Trash compacters: <br /> Ovens: 3 <br /> Other (please specify): /GLS �EA <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 Bischofberger <br /> Name p v� . Environmental Health&Safety <br /> I� 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:Pbischofbergcr@usrscrap.com <br /> DTSC Form 1488(1115/09) www.usrscrap.com <br /> Page 1 of 1 <br />