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Excluded Recyclable Material 1.Bill of Lading It 2. Document Number <br /> Manifest U�j�jS USR 2018 000 _ � I <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 /> rm Type Volume to HSC 25143.2 <br /> A. YES-lhtdrr I IS('25143 2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material lIU I D'1' 2�� Ll'"� I' Secti t�Telt"'cn"'niti I"' <br /> r Section_'eq 13 9 <br /> Q. <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 my waste 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 Signature Month Day Year <br /> l`- (: l -9 <br /> 19.Transporter 1 Acknowledgement of Receipt of Materials i <br /> Print/T pe Name SignattV Month Day Year <br /> �r (Al <br /> Transport 2 Acknowledgement of Receipt ofMat(eri rE <br /> Print/Type Name Pr' /Type Name Montle 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 5ignaturMonth Day Year <br />