Laserfiche WebLink
Department of Toxic Substances Control <br /> State of California—California Environmental Protection Agency De P <br /> Orphan Appliance Monthly Report Form - <br /> Please send this document on a monthly basis to DTSC by mailing to. R,� ;E i V El <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control ESL L 7 2016 <br /> Office of Pollution Prevention and Green Technology <br /> 1001 "I" Street, 11th Floor '--��iR��� �EiViAL HEALTH <br /> P.O. Box 806 QERRhiT/SERVT;ES <br /> Sacramento, California 95812-0806 <br /> Month: Me, Year: its l RU�GE ReCYGL,A)y *F4VCff0 <br /> Name of scrap recycling facility: 1�k cv$ <br /> Tom <br /> Facility address: `t✓ �' <br /> Ai <br /> Name of CAR: JSR � CAR # <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 /> r <br /> Microwave-. `�� Water Heaters: <br /> Washers: Air conditioners: <br /> Dryers: Trash compacters: <br /> Ovens: <br /> (Other lnlgaSe spP.Clfy): i <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 1v Enviromncntal Hcalth&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: PbischotbergerC@usrscrap.com <br /> DTSC Form 1468(1/15/09) www.usrscrap.com Page 1 of 1 <br />