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Excluded Recyclable Material 1 . Bill of lading ti 2 . Document Number 3 . Date <br /> Manifest j� t f14C� U5R 2018'000. 4/ 07 ,20 _ <br /> 4. Generator's Name and Mailing Address S . Generator's Phone t t <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 /> S. Twnsputter 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 /> No. Tyne volume to HSC 25143.2 <br /> A. V11'9% Under I ISC 25 143 2 <br /> Metal Shredder Aggregate - Excluded Recyclable Material 001 DT � 1 j 1 , C( � i' meeting requirements Ii,r <br /> Section 25411 1) <br /> i <br /> Ce <br /> DA <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 anti 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 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 mywasteand am taking advantage of new technology and existing DTSC <br /> regulations to comply with 5814 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 /> 16 ') 1 (1 % UCr r I � <br /> 1!J . 'Ctarrspurtef•_ Ackriuwiedgement oP Receipt of Materials --- <br /> Print / Type Name Slg a ure <br /> Month Day Year <br /> 20, Transporter 2 Acknowledgement of Receipt� rint <br /> erials --- <br /> Print / Type Name J i e Name Month Day Year <br /> s <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 Signa i Month Day Year <br />