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LAL-iuueu rcecyciame Material 1. Bill of LadingH 2. Document Number 3. Date <br /> Manifest USR 2018-000- � <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 /> 8.Transporter 2 Company Name 9.Transporter's Phone <br /> 10. US DOT Proper Shipping Name 11, Containers 12.Total Quantity ��Fw <br /> Pursuant <br /> No. Type 5143.2 <br /> A. <br /> der I ISC'2S 143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 D1' '�j I equirements lbr5413.9 <br /> B. <br /> C. <br /> D. <br /> 14. RecyclingFacility Name and Mailing Address 15. Facility Phone <br /> Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City, NV 89701 209-944-9555 <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 /> non-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> under 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 <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 or appearance,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 mywaste and am taking advantage of new technology and existing DTSC <br /> -egulations to comply with 513 14 by selecting the best methods that are available to me and that are economically practical. <br /> 3enerator or Authorized Representative/Print Name Signature Month Day Year <br /> DIN 9 <br /> 91 I <br /> L9.Transporter 1 Acknowledgement of Receipt of Ma n 1 _r-_ -- - <br /> rint/Type Name Signure Month Day Year <br /> W x,11 i S <br /> 0.Transporter 2 Ackn wledgement of Receipt of Mateflals <br /> rint/Type Name Month Day Year <br /> A t-611,I &-:= <br /> 1. Dis, epancy Indicati n Section <br /> i <br /> 2. Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> int/Typ Name Signature — -- --- <br /> Month Day Year <br /> l 6� 1 <br />