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1 12 (9b 3 t (fcg L <br /> SALES REPRESENTATIVE: Nick McGowan <br /> 1219 KANSAS AVENUE, MODESTO, CA 95351 _ <br /> TEL: 1.-877-4241950 <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 infornnation . Timer CT: <br /> : Y� <br /> Physical addresses only, no PO Sox's accepted. <br /> 1. Contact • Information-PLEASE PRINT CLEARLY Dater <br /> Company Name: Li (yam ' <br /> Contact persgn ; ti' y�1 W <br /> Address: c D&y 4 t u , Signature <br /> City, State, Zip : 0g 7rgz G19A E ID Driver's Lic. # <br /> Phone Number: By signing, you confirm this is your personal property. <br /> a..• V4 ,t t Oc"Ovim, 0, �' nvtd rt.r-z.e. r--<..r h cis- , C. v Mjr*6O � S� �y £'� � f .k��. � ►-, <br /> Item Quantity Weight Other Items Quantity Weight <br /> Televisions - CRT 2• P4s �i , �r <br /> Monitor - CEVV <br /> Flat Screens - CEW <br /> CPU's-Complete <br /> Laptop ( Good) <br /> Laptop(RAD) NO PAY <br /> POP <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 /> T pewriters <br /> Wire/Cabling <br />