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" <br /> State of Caiiforrda - Califomla Environmental Protection Agency pepartment of Toxic 3ub8tatwes Controt <br /> 0rahan Aaaliance Monthly '""1 ,5; <br /> Please send this d� DTSC <br /> by mailing to: <br /> Att Consumer Products Section <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green Technology <br /> 10011* Street, 11th Floor <br /> P.O . Box 806 <br /> i Sacramento, California 95812-0808 <br /> Year : D T r nr <br /> Monro . � v� -~ yc >:. � �, <br /> Name of scrap recycling facility: �� r CZ0 <br /> Facility address : <br /> G 5 � tQV46 K&YC4A)gCAR # <br /> Name of CAR : UA) f 10V C4 <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 compactors : <br /> Ovens . <br /> Other (please specify) : Nation 11111 11 <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 supmitted to my COPA, <br /> Sincerely , <br /> Universal Service Recycling, Inc. <br /> Paul Bischofbefrger <br /> Name Environmental Health & Safety <br /> YI*K 209 . 944 . 9555 <br /> FAX: 209 . 944 . 5552 <br /> CELU 209 . 855 . 1715 <br /> Contact Informi 3200 South El Dorado Street, Stockton, CA 95206 <br /> fc mail: Pbischofbcrger@usrscrap.cam page I of 1 <br /> DTSC pOmt 1468 (1l1 <br /> www.usrscrap .com <br />