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Excluoed Recyclable Material 1. Bill of Lading It 2. Document Number 3.Date Manifest I (; .'� �,j USR 2018-000- i 4.Generator's Name and Mailing Address 5.Generator's Phone Universal Service Recycling,Inc.3200 S. EI Dorado St.Stockton,CA 95206 209-944-9555 6.Transporter 1 Company Name 7.Transporter's Phone Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 8.Transporter 2 Company Name 9.Transporter's Phone 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant No. Typr Volume to I ISC 25143.2 A. 1'L.S-I Indo I ISC?i 1.1 Metal Shredder Aggregate-Excluded Recyclable Material 001 D'r I meeting icquircuicnl`161 SccIion 25413.9 D. C. D. i 14. Recycling Facility Name and Mailing Address 15. Facility Phone Universal Service Recycling Nevada LLC. 5855 Sheep Dr. Carson City, NV 89701 209-944-9555 16.Additional Description for Material Listed Above Mixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and non-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material under the provisions of subdivision(d)of Section 25143.2. 17.Special Handling Instructions — --- No special handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material 24 Hr. 209-751-9946 for Environmental Health and Safety Manager 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, pricked,marked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations. 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 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 regulations to comply with SB 14 by selecting the best methods that are available to me and that are economically practical. Generator or Authorized Representative/Print Name Signature Month Day Year 19.Transpo er rt 1 Acknowledgement of Receipt of Materials Print/Type Name Signature Month Day Year _ Eli -7 I I � 20.Transporter 2 Acknowledgement of Receipt of Materials I - — Print/Type Name Print/Type Name Montle Day Year 21. Discrepancy Indication Section L - 351� I�O //- 7�;-s u 22. Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 Print/Type Name Signatur Month Day Yeai