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Excluded Recyclable Material 1. Bill of Ladin It 2. Document Number1 r` n 3. Date <br /> Manifest �j Z USR2018-000-q4`1 U 1ci, I <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 /> G.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 /> Nu. TYPL Volume to HSC 25143.2 <br /> A. YES-Under I ISC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material OOI DT t �> -r meeting requirements lur <br /> Section 2i•I1 3.9 <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 /> Mixture 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 /> 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 dornestic 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 Representa ' e/Print Narne Signatur Month Day Year <br /> Ct1 tct <br /> 19.Transporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name Signature Month Day Year <br /> _ _) V_ X ) V ch-1cj C <br /> 20.TranspoNAM <br /> VCdgement of Receipt of Materia s <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21. Discrepancy Indication Section <br /> 22. Facility Operator:Certification of Receipt of Excluded Recyclable Materials by thi Document except as otherwise noted on line 21 <br /> Print/T pe Name Signa tur Month Day Year <br />