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r <br /> ie of calfwnla — Ce1Uamla EnvlronmeMei Projection Agency <br /> pepartmeM of To)dc Subatactces Cwdrol <br /> St <br /> haAp ,lance Ma,nNy Rang <br /> V E <br /> pp <br /> Please send this document on a monthly basis to DISC b ii E <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control N10 \1 <br /> Office of Pollution Prevention and Green Technology <br /> 1001 ,r Street , 11th Hoor <br /> P .O . Box 806 NVIRO MENTAL HEW H <br /> Sacramento , California 85812-0808 , T n ENT AR <br /> Month # J Wv Y Year : 2.0 f yc x. /moi ^z <br /> Name of scrap recycling facility : 7t toL <br /> Facility address . <br /> l� � U ,E�51� � Cj`r4✓A)gCAR # <br /> Name of CAR . U rov It4 <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 /> WE III I <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) : I III III WIN liiiiiiiiiiiiiiii 1 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 submitted to my CUPA . <br /> Sincerely , �J <br /> Universal Service Recycling, Inc. <br /> . . . . . . . . . . . . . . . . . . <br /> Paul Bmchofbelrge <br /> Name Eavimnrtwtal health & safety <br /> 209 . 944 . 9555 <br /> pAX} 209 . 944 . 5552 <br /> CELL: 209 • SSS • 1715 <br /> Contact Informl 3200 South EI Dorado Street, Stockton, CA 95206 <br /> E-mail : Pb ischofbet8erausrscrap.com <br /> DTSC form 1468 t1H <br /> www.usrsetap.com Page 1 of 1 <br /> i <br /> i <br />