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State of California — California Environmental Protection Agency Department 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 Techno <br /> 1001 'T' Street , 11th Floor <br /> P . O . Box 806 Il 701 <br /> Sacramento , California 95812 -0806 <br /> ENVIRONMEN I AL. HEALTH <br /> Month : Year: 2 0 1 8 wwffiMENT <br /> Name of scrap recycling facility : Universal Service Recycling , Inc . <br /> Facility address : 3200 S . EI Dorado St . Stockton , CA 95206 <br /> Name of CAR : Universal Service Recycling , Inc . CAR # 0363 <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 COPA . <br /> Sincerely , <br /> Steven Slatermom * massymom EHS Manager. . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . <br /> Name Title <br /> Email: ssiaterousrscrap: com Phone : (209 ) 751 - 9946 <br /> Contact Information <br /> Page 1 of 1 <br /> DTSC Form 1468 (1 /15/09) <br /> i <br />