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Excluded Recyclable Material 1.Bill of Lading 4 2.Document Number 3.Date <br /> Manifest L USR 2018-000-&N j 3 <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 13.Unit,Wt. Recycled Pursuant <br /> N. rya Volume to HSC 25143.2 <br /> A. 1'ES-tinder IiSC 25143? <br /> Metal Shredder Aggregate-Excluded Recyclable Material Doi DTT 0,\ T m ging requirements lior <br /> l Section 35413.9 <br /> B. <br /> C. <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 209-944-9555 <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 /> on-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 orappearance,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 /> regulations to comply with 513 14 by selecting the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Representative/Print Name Signatur Month Day Year <br /> G�titr..1 v r 2 <br /> 19.Transporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name Signature Month Day Year <br /> d<, -d J > �i c �� f t 16 I�{ c���� �� h I I c <br /> 20.Transporter 2 Acknowledgement of Receipt of Materials <br /> Print/Type Name Print/Type Name fvionth 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 /> Print/Type Name Signatur Month Day Year <br /> �-� S 3 t <br />