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r <br /> State of California - California Environmental Protection Agency Department of 'toXic Subatanoea Control <br /> Or ance Monthiv Report Form , <br /> Please send this document on a monthly basis to QTSC by mailing III <br /> Y Attn: Consumer Products Sectlon <br /> Department of Toxic Substances Control <br /> Office of Poilution Prevention and Green Technology <br /> 10011p Street, 11th Floor <br /> 11 <br /> P . O . Box 806 <br /> Sacramento, California 95812-0608 <br /> (`� E Year : D c tr A)4Month . Ec Aj <br /> Name of scrap recycling facility : Opt <br /> SCl4 � ` <br /> Facility address: 6 <br /> ame of CAR : U <br /> NN � V �E � SRv � 1c4a}gCAR # <br /> Total number of "orphan " appliances received this month (as indicated by use of DTSC <br /> I . <br /> Form 1459) received : <br /> This information is not required , but is appreciated : <br /> Space Heaters : Staves : <br /> Refrigerators : Boilers: <br /> Furnaces: ' <br /> Freezers : '���'' . <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 sccraap rr beelnnsupmf facility <br /> d to my CUPA,I$ included on the following <br /> This information has <br /> Sincerely , '�'��•-__.._�...�._._......_.-x <br /> Universal Service Recycling, Inc. <br /> Paul Bischotberger <br /> $ Noor * 004 spa 40461pov XjSEK <br /> safe, <br /> Name irnvironmemat Health & Y <br /> 209 . 944 0 9355 <br /> PAX. 2}9 . 944 . 5552 <br /> CELL: 209 . 855 ^ 1715 <br /> South El Dorado SUI Stockton, <br /> to kto 95206 <br /> Contact informs 3200 <br /> E-mail: Pbischofbar8 P �mPage 4 of t <br /> www.usrscrap.com <br /> i)T$C form 4488 (1f1E <br />