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Ex�clucled Recyclable Material 1. Bill of Lading ft 2. Document Number I '1 3. Date <br /> (Manifest (1,�►�:�. '� USR2018-000 U`tI �•-11- ICi <br /> 4. Generator's Name and Mailing Address 5.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 /> No. Type Volume to HSC 25143.2 <br /> A. YE.S-Under HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT ` ! ,j I. meeting requirernenis flor <br /> Section 25413.9 <br /> B. <br /> C. <br /> 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 209-944-9555 <br /> 16.Additional Description for Material Listed Above <br /> Vdxture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> non-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 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 /> Generator or Authorized Representative/Print Name Sign tore Month Day Year <br /> 1c <br /> Avti �v� ��; N <br /> 19.Transporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name Signature Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt of Materials <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21. Discrepancy Indication Section <br /> -7 <br /> 22. Facility Operator: Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21- <br /> Print/ <br /> 1Print/Type Name Signa <br /> tu Month Day Year <br /> A m a r t �.� ( � J 3 i I , <br />