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Excluded Recyclable Material 1. Bill of Ladin It J^ 2. Document Number_ <br /> y g ----- ------ 11 Date <br /> Manifest i ' t tJSR 2Ci .f3-QUO- ' -t ! 60 I <br /> ! i <br /> 14, Generator's Name and Mailing Address 5 . Generator's Phone <br /> i <br /> ; Universal Service Recycling, Inc. 3200 S. El Dorado St. Stockton, CA 95206 209-944-9555 <br /> 16. Transporter 1 Company Name 7 . Transporter's Phone l <br /> IUniversal Service Recycling, Inc. 3200 5. El Dorado St. Stockton, CA 95206 209-944-9555 <br /> ' d. 1 ransporLer L L.otnpany Naine - � 9 . 1 ransporter's Mono l <br /> ' 104 US DOT Proper Shipping Name 11. Containers 12. Total Quantity 13. Unit, wt. Recycled Ptirsuant j <br /> +� lune Volume to HSC 21St43.7 <br /> A, — `_---- }' tti• ( inkier iiti( ' , fit is <br /> Metal Shredder Aggregate - Excluded Recyclable Material iilii Will � CP tit'C tti+ rtYllli i'�ineYlt> 1±,i' i <br /> fE ! sectfoo !351 13 i) <br /> 114. Recycling Facility Name and Mailing Address 15 . Facility Phone _^ <br /> , <br /> ' Universal Service Recycling Nevada LLC. 5855 Sheep Dr. Carson City, NV 89701 .209-9449555 - <br /> 16 . Additional Description for Material Listed Above <br /> ,Mixture of materials containing plastics and recoverable metal; coarse and fine-grained materials including recyclable metals, recyclable plastics, and <br /> IP.ion-recyclable materials including foam rubber, insulation materials and entrained soil and grit. Shipped aggregate is an excluded recyclable material l <br /> ander the provisions of subdivision (d) of Section 25143,2 . _ _ - <br /> 17 . Special Handling Instructions —� <br /> No special handling required; inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material j <br /> 24 Hr. 209-751-9946 for Environmental Health and Safety Manager l <br /> i <br /> 1$. Generators Certification: i hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified. <br /> racked, marked, labeled and are in all respects in proper condition for transport according to applicable domestic regulations. <br /> I also recognize that in spite of product pante or appearance, these commodities are being recycled and are either non hazardous or conditionaily rxt!mi.+t fron, <br /> hazardous waste: regulations. As the generator, i anI making a good faith effort to minimize my waste and am taking advantage of new technoloi;y ane( existing DTSG 1 <br /> egulations to comply with SB 14 by selecting; the best methods that are available to me and that are economically practical. <br /> _ t <br /> =.generator or Authorized Representative 1 Print Name Signat Month Day — Ye+a+ <br /> 19* l o <br /> Acknowledgement rans orter 1f 4 a � <br /> p Receipt of Materials - <br /> Print / Type Name nat <br /> ., Month Day Year <br /> ?tS. Transporter Z A knowle gement of Receipt of <br /> print J Type Name print J Type Name Month Day Year <br /> i <br /> Z1. Discrepancy Indication Section - <br /> 22 . Facility Operetor�Certirication of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print / Type Name 4Signatu Month Day Yaar <br />