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Excluded Recyclable Material Bill of Lading ft2. Document Number 3. Date <br /> 1. <br /> Manifest /)c ? USR 2018-000-�� <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 /> 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 /> Nu. Tyr.- Volume to HSC 25143.2 <br /> A. _ VES-Under I ISC 25143.? <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 Wl' U'D I. tnectinp requirements Ibr <br /> Section 25413.9 <br /> B. <br /> C. <br /> D. <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 /> 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 /> 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 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 or appearance,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 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 to me and that are economically practical. <br /> Generator or Authorized Representative/Print Name Signature Month Day Year <br /> \_ 11 <br /> 19.Transporter 1 Acknowledgement of Receipt of Materials <br /> Print/jype Nameigna re Month Day Year <br /> O <br /> 20. ransport 'r 2 Ac owledgement of Receipt of teri <br /> Print/Type Name Print/ `e 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 /> Print/Type Name > Signature (� 1 Month Day Year <br /> �_J i OA C1 Y A �J. J J 81 1 Ot <br />