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w ' <br /> State of California — California Environmental Protection Agency <br /> Department of TOKtc Subetaitoe>ti Cortimt <br /> Orphan Appliance Monthly Report Form a <br /> Please send this Consumer Products Qrod cts Sectioonthly basis to nC by mailing to : <br /> A <br /> Department of Toxic Substances Control <br /> office of Pollution re Prevention <br /> llth Floaen Technology <br /> 01 <br /> P .O . Sox 806 <br /> Sacramento, California 95812-0806 <br /> Month : 16 Year : >�Q S <br /> �' y 11 IG �Ey� Lig <br /> / 3 11 <br /> Name of scrap recycling � � <br /> facility : <br /> vJER �— <br /> E �. �aAr�p � <br /> Facility address : %, �' o s. D� <br /> Name of CAR : S ,Egv1C6 I 1`64 ''�gCA�R # --� <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 /> Spars Heaters : Stoves : <br /> Refrigerators: Bailers : <br /> Freezers : Furnaces. <br /> Microwaves . Water Heaters : . <br /> Washers : Air conditioners : <br /> Dryers : Trash compacteil <br /> Ovens . <br /> Other (please specify} : JINX MONSOON IN <br /> The names and addresses of each person who transported , delivered , or sold pages . <br /> "orphan" <br /> Thisinfces to ormation hasrap recya so been upmitted to my Cill ing facility is Included on the following <br /> This ln# <br /> Sincerely , ` <br /> Universal Service Recycling, Inc. <br /> paui Bischofberger <br /> . . <br /> Name ,v Environmental Health & Safety <br /> Z04 . 944 . 9555 <br /> FAX ; 209 . 944 . 5552 <br /> CELL: 209 . 855 . 1715 <br /> Contact tnformi 3200 South Et Dorado Street, Stockton , CA 95206 <br /> E-mail: Pbischoiberger@usrscrap.com Page 1 of 1 <br /> DTSC Form 4488 NMS <br /> www.usrscrap.com <br />