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cop <br /> SALES REPRESENTATIVE . Nick McGowan <br /> 1219 KANSAS AVENUE, MODESTO, CA 95351 <br /> TEL : 1-8774244950 <br /> ELECTRONIC WASTE RECOVERY CENTER <br /> Instructions. <br /> Please complete the information below in reference of each shipment of electronics . <br /> Approximation is okay. Feel free to attach any supplementary data or information . Time: ` (D : Z� ( <br /> Physical addresses only, no PO Box's accepted , <br /> I . Contact information- PLEASE PRINT CLEARLY Date : C I - � 7 f 1 <br /> _Company Name : jD <br /> Contact Person : j � G *Address: S / ! Signature �c� �i �t 4/ti/C(/}ECity, State, dip : p ,� � � l��"-'�' Driver' s Lic. # <br /> Phone Number: / � � By signing, you confirm this is your personal property. <br /> s'> .i <br /> !tern Quantity Weight Other Items Quantity Weight <br /> Televisions - CRT 10:i - <br /> Monitor - CEW 1 � } <br /> Flat Screens - CCW <br /> CPU ' s-Complete <br /> Laptop (Good ) �- <br /> Laptop ( BAD) NO PAY <br /> LCD 's ( Good) <br /> LCD 's ( Bad ) NO PAY <br /> Tablets <br /> kPads <br /> Printer (X" Large ) <br /> Printer ( Large) <br /> Printer ( Medium ) <br /> Printer (small) <br /> Scanners <br /> Keyboard / Mice <br /> VCR <br /> Stereo / Tape / CD <br /> Copiers <br /> Fax Machines <br /> Misc , CPU Parts <br /> Microwaves <br /> Typewriters <br /> Wire/Cabling <br />