Laserfiche WebLink
Excluded Recyclable Material 1.Bill of•Lading# 2.Document Number 3.Date <br /> Manifest USR 2018-000-_ <br /> 4.Generator's Name and Mailing Address S.Generator's Phone <br /> . <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal teryice'Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> f#e <br /> 8.Transpor� mpany Name 9.Transporter's Phone <br /> ::offal De•,cr <br /> mat4,11.•rr� <br /> 10. Uk[5OT proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> u'OdT pty ql per <br /> .. 10. No. Type <br /> _ Volume to HSC 25143.2 <br /> Sneria 1 lin'! ws: ,c i rr <br /> ES-Under HSC 25143,2 <br /> Al.-)special handling 'et. I it <br /> MetalLSjg�l4�,rgregate-Excluded Recyclable Material 001 DT T. meeting requirements for <br /> IT <br /> 51Section 25413.9 <br /> B. ators r�rtificatioo:i hers <br /> k� ,'.hereri i are <br /> C. v r <br /> D. <br /> 14.RecyelihkLFacility Name and Mailing Address 15.Facility Phone <br /> -A <br /> ,,t <br /> ;e <br /> Universal SeW�cd Recycling Nevada LLC.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <br /> 16.Additional Description for Material Listed Above <br /> Mixture-of•materigls Containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> on-recydbile materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> nrlei h ►fi�i ns of subdivision(d)of Section 25143.2. <br /> 17.Spacialj�proi%kgstructions <br /> No spec{ I�qiqd�iaAr"uired;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material <br /> iscrspaJ1cN1i+30ir er 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 Lhe 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 SS 14 by selecting the best methods that are available to me and that are economically practical. <br /> Generator or AuthOrJzed Representative/Print Name Signature Month Day Year <br /> (ow'-'M Nava V rt 3-Z►- <br /> 19.Transportef=1-A owledgement of Receipt of Materials <br /> Print/Type-NaM V signature Month Day Year <br /> " <br /> ` `3 <br /> 20.Transporter 2 Acknowledgement of Receipt of Ma rials <br /> Print/TWA N }q2 Print/Type Name Month Day Year <br /> tiARYMA;:K Q,'IV' <br /> 76115'FA S,T.IiR. ; <br /> 21.DiSrrhpAnotgt@0tion s.50tion <br /> 22.Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> t <br /> Print T pe Name <br /> Isi, <br /> nat Month Day Year <br /> 3 2 l <br /> E <br />