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Excluded Recyclable Material 1.Bill of Ladi g 2.Document Number O 3. Dat <br /> Manifest USR 2018-000- <br /> Q 19 <br /> 11.Gvnerator's Name and Mailing Address 5.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.El 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 /> Nu. Ivrre Volume to HSC 25143.2 <br /> A. YEs-Ihtdel IIst 251-I; <br /> Metal Shredder Aggregate-Excluded Recyclable Material (101 IVF I' inceln^ieilrinenleuls Gn <br /> � Secnun'?I I i N <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 /> 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 i <br /> 24 Hr.209-751-9946 for Environmental Health and Safety Manager <br /> 18.Generators Certilication: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 Iron <br /> hazarclous waste regulations.As the generator,I am making a good faith effort to minimize my waste and am laking advantage of new technology and existing DISC <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 <br /> eneratororAuthorized Represents Print Name Signature Monthr Day Year <br /> Ci t C <br /> 19.Tr nsporter 1 Acknowledgement o Receipt of Materials <br /> Print/type Name Signatur Monpt Day ear <br /> 20.T)nsp®rn2_1 cknowledgement of Receipt of Materials -- -- � -- -- <br /> P <br /> Print/Type Name Pri ype Name Mol ith Day Year <br /> 21. Discrepancy Indication Section — — — — <br /> 22.Facility Operator:Certilication of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line-2-1— <br /> Pi int <br /> ine21Print/Type NameSignaturY 1 Month Day Year <br /> rr <br /> 1iA w�/i� ki <br /> V <br />