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ExclVd�d'ft'4cyclab(4'Material 1.Bill of Lading# 2.Document Number 3.Date <br /> Man1fegslt USR 2018-000-AD3_6 _ <br /> 4.Generator's Name and Mailing Address S.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-9449555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal.Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 8.?Yarisporter 2 Company Name 9.Transporter's Phone <br /> �,Ciut <br /> 10.US DOT PeopewcShipping Name • 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> IS'It No. Type Volume to HSC 25143.2 <br /> A. ES-Under HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT M 'i meeting requirements for <br /> o4J Section 25413.9 <br /> B. <br /> ,rrG <br /> C_.ardc��sty,st, ~ toh. <br /> '.UlB tif115' .•nly � <br /> D: d <br /> 14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <br /> 16.Additional Description for Material Listed Above <br /> Mixivice-of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> non-recyclable mAirials 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 /> hazaf"i,aup regulatl86s.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 5844 by selecting the best methods that are available tome and that are economically practical. <br /> -It T.. - <br /> Generator or Authorized Representative/Print N e Signature Month Day Year <br /> `_Talmmc� Nava�Y�. �' <br /> :3-4-19 <br /> g <br /> 19.Transporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type NameMonth Day Year <br /> Si atur <br /> n <br /> 20.Trihsporterp Acknowledgement of Receipt of Mat a <br /> Print/Type Name Rc nt/Type Name Month Day Year <br /> 21.Discrepancy Indication Section <br /> i< <br /> 22;FabUity 0peratdgrCertification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name - Signur Month Day Year <br />