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Excluded Recyclable Material 1.Bill of Lading ft /� 2.Document Number3.Date <br /> Manifest tU`i5q� USR 2018-000-_1L-L__7 <br /> 4 <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 /> 6.Transporter 1.Campany Name 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> .Srarisporter 2 Company Name 9.Transporter's Phone <br /> io A( <br /> n-':Av; _-r. <br /> 10. U_DOT Proper,Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> No. Tvpe Volume to HSC 25143.2 <br /> A, ES-Under HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT �f1-'� T meeting requirements for <br /> C�c,JSection 25413.9 <br /> B. <br /> C. <br /> D. <br /> 14. Recycling FacilitV,Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <br /> 16.Additional Description for Material Listed Above <br /> 1itt lre•of•maferials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> on-re4 laP�i'e materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> ndert ,0j6yIsions of subdivision(d)of Section 2Si43.2. <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 /> I also recognize that in spite of product name orappearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazardous 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 /> Generator or Authorized Representative/Print Name Signatu Month Day Year <br /> 19.Transporter 1 AcknowWdgement of Receipt of Materials <br /> print/Type Name Sign a Month Day Year <br /> 7 / <br /> 20: ratl40 <br /> ,0100 Acknowledgement of Receipt of MatdAWFj <br /> Prldt/.Type.Name QfInt/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 Signature A Month Day Year <br />