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2.Document Number <br /> Ex-luded Recyclable Material i.Bill of Lading 0 USR 2018-000-�c��II�,..� <br /> Manifest `^ 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.TransporS5 Phone <br /> 6.Transporter 1 Company Name <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 g,209-944-9S55 TransporPhone <br /> 8,Transporter 2 Company Name <br /> 10.US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,wt. Recycled Pursuant <br /> No. tvpe Volume to HSC 25143.2 <br /> Under I ISC 25143? <br /> A. 001 DT t(,(_., 1' neeting cments lilt <br /> Metal Shredder Aggregate-Excluded Recyclable Material ce tion25413.954I3 <br /> . <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 <br /> 209-944-9555 <br /> 16,Additional Description for Materiai Listed Above <br /> fixture 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 /> nder the provisions of subdivision Id)of Section 25143.2. <br /> 17.Special Handling Instructions <br /> No special handling required;inquiries contact: 24iHrr200Service <br /> ;1i 9946 for lEnviron ental Health and ng Project-Excluded iSafety 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 falth 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 /> Month Day Year <br /> Generator or Authorized Representative/Print Name Signature n <br /> 1, .. v C,� (CA <br /> t k-)\/ <br /> 19.T ansporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name <br /> Signature Month Day Year <br /> rl� ., . / 3 ICY• <br /> 20. sporteri gem <br /> 2 Acknowledent of Receipt of Materials <br /> Print/Type Name <br /> =PrintName 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 /> Signatu Month Day Year <br /> Print/Type Name (� �� <br />