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Print I Clear <br /> State of California — California Environmental Protection Agency Department of Toxic Substances Control <br /> Orphan Appliance Monthly Report Form <br /> Submit this report on a monthly basis to DTSC : <br /> Department of Toxic Substances Control <br /> Attn : HWMP — Orphan Appliance Report <br /> 1001 " 1 " Street, 11th Floor <br /> P . O . Box 806 <br /> Sacramento , California 95812-0806 <br /> or <br /> CARQdtsc . ca . gov <br /> Report Month : 4 Zo 7'� Year : 2019 <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 <br /> DTSC Form 1459 received ) <br /> The information in the table below is not required , but is appreciated : <br /> Space Heaters : Stoves : Refrigerators : <br /> Boilers : Freezers : Furnaces : <br /> Microwaves : Water Heaters : Air conditioners : <br /> Washers : Dryers : Trash com acters : <br /> Ovens : Other : (please specify) <br /> The names and addresses of each person who transported , delivered , or sold " orphan " appliances to <br /> this scrap recycling facility is included on the following additional pages or the included DTSC 1459 <br /> forms . This information has also been submitted to my CUPA . <br /> Steven Slater EHS Manager <br /> Name Title <br /> (209) 751 -9946 ssiater@usrscrap . com <br /> Contact Information <br /> DTSC 1468 (7/10/19) <br /> E <br />