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<br />. <br /> <br />ELECTRONICS RECYCLING RECEIPT <br /> <br />California <br /> <br />Customer Name: <br /> <br />Contact Name: <br /> <br />Oate: <br /> <br />Collection Date <br /> <br />HB <br /> <br />Zip: <br />SO <br /> <br />Street: <br /> <br /># <br /> <br />City: <br /> <br />State: <br /> <br /> (drcle one) <br />Item: Quantity: UnU: Disposal PrIce: Total Price: Notes/Price Adjustment: <br />CRT (up to 17") ea. $15.00 (j>,IStc b,!tTOdc IJhe! here) <br />CPU (Desktop PC) ea. $1O,()0 {('as Ie narcotic IJhcl here) <br />Keyboard ea. $3.00 <br />Mouse ea. $1.00 <br />Power SUDDlv lb. $0,65 without batteries <br />Computer - Portable ea. $7,00 laptop, Dot combo <br />Printer - desktop ea. $7.00 (under 20 lb.) <br />Desk Copier ea. $20.00 not all-in-one or multi-function writ <br />FreeStandiDg Copier lb. $0,65 <br />CDIDVD Player, Tape Drive ea. $3.00 <br />Fax machine ea. $13.00 not all-in-one or multi-function unit <br />Scanner ea. $6.00 Desktop scanners only <br />Cables ea. $0,60 <br />Network Hubs/Switches ea. $8.00 <br />Television (under 20") ea. $30.00 (Pasle harcode lahe] IKrc) <br />Television (21 "-301t) ea. $40,00 (Pash: harcode l<Jbcl hen:) <br />Television (31" and up) ea. $53.00 (PasLe hurcodc lahe! herc) <br />Television - console ft. $19.00 Price per linear foot. If projection TV. use that category. <br />Television - projection ea. $80,00 (!\Js1c harcode lube! here) <br />Cell phone wlbatt ea. $5.00 <br />Microwave oven lb. $0,65 <br />VCR ea. $7,00 <br />Toaster/toaster oven ea. $5.00 <br />Iron ea. $4.00 <br />Telephone ea. $4.00 <br />Batteries (all) lb. $2.35 <br />Stereo console ft. $18.00 <br />Speaken It. $18.00 <br />General lb. $0,65 <br />Stop Charge ea. $40,00 <br />TOTAL COST: <br /> <br />Phone: <br /> <br />Fax: <br /> <br />Other <br /> <br />Method of Payment: Cash: Check (enter number): <br /> <br />Curbside Inc. nor any sponsoring public agency is responsible for data that was not removed from stomge media unless Curbside has been separately compensated as evidenced by a separate <br />receipt for destroying storage media. We will take precautions not 10 damage your home or furnishings in any "o/Øf if we are asked 10 enter your home 10 rnmove large items such as console TV's and <br />rad"lOS. However, you agree by signing this document that CUrbside Inc. is nol: responsible for any damage thai be caused by our employees should you elect 10 have our employees remove <br />electroniciterns from 'iOUrhome. <br /> <br />Signature: <br /> <br />Date: <br /> <br />Received by: <br /> <br />Copyrigbt C 2004 Curbside, Inc. <br /> <br />8/10/2004 <br /> <br />Exhibit A <br />