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Excluded Recyclable Material 1.Bill of lading# 2.Document Number r- 3.Date <br /> Manifest• •, ,li USR 2018-000-0 5 �j � C <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 209-944-9555 <br /> Transpot7er=1lompany Name 7.Transporter's Phone <br /> 14. Rel+y�IitfFa'ci.rt.4 i <br /> UnjYer aJ' pF:v(ge Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> 8. ranspo. ` ame - 9.Transporter's Phone <br /> t. Jltional Description ft <br /> r.of mster10- .r,. min; <br /> 10.U DO`f Proper _I�ping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> . 4 <br /> -- -- No. Type Volume to HSC 25143.2 <br /> r:7 N;,r ;r <br /> A.,;ueci:�h:.• . � ES-Under HSC 25143.2 <br /> Metal Shredder.�nregate-Excluded Recyclable Material 001 DT �p. (P T eeting requirements for <br /> Section 25413.9 <br /> B. „ tH catr <br /> C. ;t, g <br /> c:r•.to curripl <br /> D: <br /> 121,Tfi lfKAWa`cilityrName'and Mailing Address 15.Facility Phone <br /> �r �•T..a� am •::F:cy <br /> n versa ery ce Re cling Nevada I.I.C.5855 Sheep Or.Carson City,NV 89701 209-9449555 <br /> 16.Additi6nal,Descriptl6n for Material-Listed Above <br /> Mixture of materials c ntaiii ng plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> A, materials hidlueding foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> nd@r the pr6dslons 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 /> also recognize that in spite of product name or appearance,these commodities are being recycled and are either non-hazardous or conditionally exemptfrom <br /> hazardous wastp rAgulations.As.the generator,I am making a good faith effort to minimize my waste and am taking advantage of newtechnology and existing DTSC <br /> regulations tocomply with 5814 by selecting the best methods that are available to me and that are economically practical. <br /> `dame- <br /> Generator or Authorized Representative/Print NaSignature Month Day Year <br /> Na,varr _ ��_M <br /> 19:Tif t>t porter l'AcK owledgement of Receipt of Materials <br /> prirtf/`f-�id a�1ed Si a lMonth Day Year <br /> 2 .Transpdrter &hO' lodgement of Receipt of <br /> Print/Type.Name-. ..i• Print/Type Name Month Day Year <br /> 21.Discrepancy'Indication Section <br /> • tiOt <br /> 22.Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Tpe Name Signature Month Day Year <br /> N�,Iudrid iEv l5 i <br />