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Excl deft ecyciable Material 1.Bill of Lading ti 2.Document Number 3.Date <br /> 1lflanifest' (p()(p vZ USR 2018-000-6y3 3-18-J <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 209-944-9555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S._EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> S.f4grisporter 2 Company Name 9.Transporter's Phone <br /> 10.l�$TDR perShipping Name 11. Containers 12.Total Quantity 13.unit,Wt. Recycled Pursuant <br /> No. Type Volume to HSC 25143.2 <br /> --gal -lanrl r : <br /> A. -i-1 nanr.1-n. rr ES-Under HSC 25143,2 <br /> Meta(Shredder Aggregate-Excluded Recyclable Material 001 DT Q� T meeting requirements for <br /> Section 25413.9 <br /> C <br /> •arlo. . •. <br /> D:Oerat(" „ 'uv �. <br /> 14,-Wftycling Facility NaYne and Mailing,Address 15.Facility Phone <br /> Unl'Ver6l Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <br /> 16..Aoditionai Description for Material Listed Above <br /> fixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> •i,i N.. <br /> ori-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> rider thepprovisions of subdivision(d)of Section 25143.2. <br /> 17.Special,Handlag Instructions <br /> No special han`d(ing required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material <br /> p,:,•;=r�'� 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 or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazaFddurWaste 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 /> egulatlons to comply with SB 14 by selecting the best methods that are available to me and that are economically practical. <br /> Print/ I tic Mn <br /> Generator or Authorized Representative/Print ame Signatur Month Day Year <br /> 5 <br /> 19.1ransporter i nowledgement of Receipt of Materials <br /> Prirft/'type Name Signature Month Day Year <br /> ,.-I A <br /> 03 p 9 <br /> 20.Transp iter 2 Acknowledgement of Receipt of Materia <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.piscrepancy Indication Section <br /> 1-- 3-77,90 <br /> 22.Fatilj>'Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/T~pe Name Si natur <br /> TyOe g Month Day Year <br /> �4 J <br /> J <br />