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2.Document Number 3. Date <br /> Exclutfed Recyclable Material 1.Bill of Lading it US <br /> 2018 000 c l 1 1 <br /> Manifest <br /> 5.Generator's Phone <br /> 4.Generator's Name and Mailing Address <br /> 209-944-9555 <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 7,9-944-9555Transporter's Phone <br /> 6.Transporter 1 Company Name <br /> 209-944-9555 <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 g,9-944-9 Transpo555 Phone <br /> 8.Transporter 2 Company Name <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,w[. Recycled Pursuant <br /> Nu. Type Volume to HSC 25143.2 <br /> 1'I{ti.tII1dCr I ISC 251.13 2 <br /> A. 601 D'I' ! 1' nlccUng rcyuiremenu tier <br /> Metal Shredder Aggregate-Excluded Recyclable Material ( Section 2,3413.9 <br /> B. <br /> C. <br /> D. <br /> 14. Recycling Facility Name and Mailing Address <br /> 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 /> nd fine-grained materials including recyclable metals,recyclable plastics,and <br /> Mixture of materials containing plastics and recoverable metal;coarse a <br /> non-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> nder the provisions of subdivision(d)of Section 25143.2. <br /> 17.Special Handling Instructions <br /> No special handling required;inquiries contact: able Material <br /> 241Hrr209-751-9946 for vesal Service lEnvironmental H ng Project-Excludealth and lSafety 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 <br /> Month Day Year <br /> 19.Transporter 1 Acknowledgement of Receipt of Material <br /> Print/Type Name Signature Month Day Year <br /> •7 � l <br /> C <br /> ��l y <br /> 20. ranspo ter 2 Acknowledgement of Receipt of Materials <br /> Print/Type Name Print/Type 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 Signatur Month Day Year <br />