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Excluded Recycla;bel 1. Bill of lading It 2 . Document Number <br /> Manifest I Date <br /> USR 201&000- ' > <br /> 4. Generator's Nang Address - ---- <br /> 5 . Generator's Phone <br /> Universal Service c. 3200 S. El Dorado St. Stockton, CA 95286 <br /> 6. Transporter 1 Coe _ 209'344-9555 <br /> 7 . Transporter's Phone <br /> Universal Service Rc, 3200 S. EI Dorado St. Stockton, CA 95206 <br /> 8 . Transporter 2 Company Name 209-944-9555 <br /> 9. Transporter's Phone —"- <br /> 10. U5 DOT Proper Shipping Name 11 . containers <br /> 12. Total Quantity 13 . Unit, wt, Recycled Pursuant <br /> No. Type <br /> A Volume to HSC 25143.2 <br /> Metal Shredder Aggregate - Excluded Recyclable Material Ontlyf yllts- I hider I IS(' ,s iAl t <br /> ' ` i' meeting requirements fin <br /> $ Srctiun 25413.9 <br /> C. <br /> D. <br /> 14 , Recycling Facility Name and Mailing Address <br /> 15. Facility phone <br /> Universal Service Recycling Nevada I.I.C. 5855 Sheep Dr. Carson City, NV 89701 <br /> 16 . Additional Description for Material Listed Above 209-944`8555 <br /> Mixture of materials containing plastics and recoverable metai; 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 /> rider 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 /> `i <br /> 24 Hr. 209-751-9946 for Environmental Health and Safety Manager <br /> 1$ . Generators Certification: i hereby declare that the contents of this consignment are fully and accurately described above b <br /> packed, marked, labeled and are in all respects in proper condition for transport according to applicable domestic regulations . shipping name and are classified, <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, f am making a good faith effort to minimize my waste and am taking advantage of new technology regulations to comply with SB 14 by selecting the best methods that are available to me and that are economically practical. and existing t?TSC <br /> Generator or Authorized Representative / Print Name Signature <br /> Month Day Year <br /> 111 Transport,-1 Acknowledgement of Receipt of Materials { � -C <br /> Print / Type Name — <br /> Signature <br /> Month Day Year <br /> 20, Transporter 2 Acknowledgement rf Receipt o 'Matertal � Z <br /> 3 -- o II <br /> Print / Type Name Printf Type Name �– 1 <br /> 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 /> -_ <br /> Print type Name - – — _ . _ . . <br /> Il(L Signatur <br /> Month DaY Year <br />