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Exclu bed Recyclable Material 1.Bill of Lading# 2.Document Number 3.Date <br /> LAanifest . 1 (00535 1 USR 2018-000-t71-f2 <br /> 4.Generator's Name and Mailing Address S.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> Transporter 1 Company Name 7.Transporter's Phone <br /> . Pt <br /> Universa)Ser0ce Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 8.' .cansporter 2 Company Name 9.Transporter's Phone <br /> � ,�dliiorl • � <br /> -if',r eriats,eonia . <br /> 10,U,5 DOT Proper ip9m�Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> iv ion u; ,e., <br /> Sm. JI1:1 -C No. Type Volume to HSC 25143.2 <br /> A. •-cries YES-Under HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded-Recyclable Material 001 DT Zp.L1 T eeting requirements for <br /> ection 25413.9 <br /> B. <br /> r <br /> C. <br /> D. iu'a;,,or <br /> 14.rrR��ecycling Facility Name and Mailing Address 1S.Facility Phone <br /> �Jn`�v'ersiaket4ice Recycling Nevada I.I.C.S8SS Sheep Dr.Carson City,NV 89701 209-9449555 <br /> 16.Additional Description for Material Listed Above <br /> Mixtyre-of-matel ining plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> 1:X r n wit , <br /> non-recyclable ma erfa s Pnciuding foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> ndgr the prQNisioris 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 <br /> 24 Hr.209-751-9946 for Environmental Health and Safety Manager <br /> 18.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 /> packed,marked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations. <br /> 1 also recognize that in spite of product name or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> haYaMous waste regulations.As the generator,I am making a good faith effort to minimize my waste and am taking advantage of new technology and existing DTSC <br /> regulations to comply with SB 14 by selecting the best methods that are available to me and that are economically practical. <br /> im• <br /> Generator or Authorized Representative/Print Name Signatur Month Day p� Year <br /> n �" ' �—) / <br /> "Cowl ua rYe <br /> 19.Transportee\j Acknowledgement of Receipt of Materials <br /> Print/ pe Name Si to a Month Day Year <br /> 6� / <br /> 20.Transportafr 2 Acknowledgement of Receipt of teri <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.Discrepancy Indication Section <br /> 22.Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name Slgnat Month Day Year <br />