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Excluded Recyclable Material 1.84of Lading# 2.Document Number 3.Date <br /> i Wanifest $(10 USR 2018-000-0149 3-t 3 rte <br /> 4.Generator's Name and Mailing Address 5.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal SeN,Ice Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 8.-Transporter-2 Comp' ny..Name 9.Transporter's Phone <br /> US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> —•- No. Typo Volume to HSC 25143.2 <br /> a- ES-Under HSC 25143.2 <br /> Metal Shresdder Aggregate-Excluded Recyclable Material 001 DTt C'i f T meeting requirements for <br /> i ISection 25413.9 <br /> B. irn 'nr,rrb} <br /> C. rp'' <br /> D. <br /> 14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal SeriiIce Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <br /> 16.Additional Deslaription 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 /> eilon4ecyclable materials including foarh rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> rthe provisions of subdivision(d)of Section 25343.2. <br /> 17yppecia�IrHandling Instructions <br /> No,special handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material <br /> •i ,i3crel) r+dic 24 Hr.209-751-9946 for Environmental Health and Safety Manager <br /> 18.Generators CehUcat>'o"N 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 recognizethat in spite of product name or appearance,these commodities are beingrecycled and are either non-hazardous orconditionally exempt from <br /> hazardous waste regulations.As the generg%10 am making a good faith effort to minimize my waste and am taking advantage of newtechnology 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 /> Generator or Authorized Representative/Print Name Signatur Month Day Year <br /> 19.Transporter 1 Ack ledgement of Receipt of Materials <br /> Print Signature ` Month Day Year <br /> 01 <br /> ?r0.Transporter 2 Ackno ledgement of Receipt of Mfiferials <br /> rinpjrType Name Print/Type Name Month Day Year <br /> 5. I ra s for <br /> 7r�Digdedpancy Indication Section <br /> vp <br /> • .,inn( -•. L' <br /> 22.Facility Operatog,Certification*146cieipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name — Signa Month Day Year <br /> ` 3 t 3 • (Ot <br /> Et <br />