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Exclucl l#Recyclable M tterial 1.Bill bf Lading# 2.Document Number 3.Date <br /> Manifest (00�� USR 2018-000 <br /> 4.Generator's Name and Mailing Address S.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.El 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 DOY,Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> '�'•'u�tSl� "- No. Type Volume to HSC 25143.2 <br /> YES-Under HSC 25143.2 <br /> A. 1 3t:u <br /> Metal S r�d��e�r,Q ggregate-Excluded Recyclable Material 0011 DT i (� ' T meeting requirements for <br /> 1 Section 25413.9 <br /> B;. wrators Certit- _J:. <br /> K eked. <br /> C. +Jln :iii -r•Ar <br /> D. <br /> 14.Recycling Facility 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 /> Mixture of materials containipg plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> non-recycIdW materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> under,thelxp on;of subdivision(d)of Section 25143.2. <br /> 17.Spetrial..Handling Instructions <br /> No special handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material <br /> iii s:reparicy'Ir `c, 24 Hr.209-751-9946 for Environmental Health and Safety Manager <br /> 18.GeneiJors Cert ficatton:l 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 /> hazaFdousWafte reg WtWR§I.r'7fdthe generato'f;f,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 tome and that are economically practical. <br /> Generator or Authorized Representative/Prin Name Signatu Month Day Year <br /> rnM N�,Uarr� -� <br /> 19.Transporter lWknowledgement of Receipt of Materia <br /> '19— <br /> Print/Type Name"'7 <br /> Signature Month Day Year <br /> 20.Transgq�br AcknowlQdgement of Receipt of Materials <br /> Print/Type:wl%OWf: Print/Type Name Month Day Year <br /> 21.Discre eifO1,Ihdidation Section hl -77660 <br /> ho of nvisl i <br /> i I :,,.a.i •.r r-qu., <br /> 22.Facil1jr d#ff"rC@ffiification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name • - Signature Month Day Year <br /> ICAJI c' W <br />