Laserfiche WebLink
1 <br /> State of California—Callfornit ronmental Protection Agency 'partment 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 <br /> Office of Pollution Prevention and Green Technology AUG 'U 8 20 <br /> 11 <br /> 1001 "1"Street, 11th Floor <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> Month: 1 v G,../ Year: <br /> Name of scrap recycling facility: (i��/� -a� �`�<. `; :/�����: ._ h-`_ C-r IA-)`?- <br /> Facility address: —3c)_0 C-) �Sc., ��'�.ff E L Q <br /> Name of CAR: U5 it. CAR # <br /> c`� .� 5 . <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 Bischofberger <br /> Name Iv Environmental Health&Safety <br /> R 1 L <br /> 209.944.955 5 <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@usrscrap.com <br /> DTSC Form 1468(1116/09) www.usrscrap.com Page 11 of 1 <br />