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;Excluded Recyclable Material 11. Bill of Lading ff 2. Document Number �,-u 3.D to C <br /> Mani€test USR 2018-000-2L <br /> �4.Geneiator's Name and Mailing Address 5.Generator's Phone <br /> IUniversal 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. El Dorado St.Stockton,CA 95206 209-944-9555 <br /> 8.Transporter 2 Company Name 9.Transporter's Phone <br /> i <br /> t10. U5 DOI' Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt, Recycled Pursuant <br /> No. <br /> Volume to HSC 25143.2 <br /> !A — — YES-Under I ISC 25113.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT I� � T meeting requirements I'or <br /> v Section 25413,9 <br /> rD_— <br /> 14. Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LLC. 5855 Sheep Dr. Carson City, NV 89701 209-944-9555 <br /> U /W. Iitlonal De•,ci iption 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 5ection 25143.2. <br /> 47.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 /> -, r t iwnow I hereby declare that the cuntenls of this consignment are fully and accts ately described above by proper shipping name and are classified, <br /> „1 rOc labOo0,1110 are in all respects in proper condition fur transport according to applicable domestic regulations. <br /> r•... „,ruin t hat ut spite of pr oduct name or appear ante,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> -J101,11; r.•I Au'r egulot ions.As the generator,I am making a good f with effort to minimize my waste and am laking advantage of new technology and existing DISC <br /> egulat uo, to comply with SB 11 by selecting the best methods that are available to me and that are economically practical. <br /> t <br /> i <br /> f6eneiator or Authorized Representative/Print Name 5i Month Day Year <br /> tti. 1iarrsporter 1 Acknowledgement of Receipt of Ma I Is <br /> 'runt/ lype Name Signa Month Day <br /> Year <br /> ISO.Transporter 2 A gement of Receipt of Materials <br /> Pi int/ IYhe Name--^—— — --- f Tint/T ype Name — — Month Day Year <br /> 21 Discrepancy Indication Section <br /> 22. Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Nrinl/Type Name Signature Month Day Year <br />