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Excluded Recyclable Material 1.Bill of L ding H 2. Document Number 3. Dale <br /> Manifest C _ USR 2018-000- L <br /> 4.Generator's Namr.and Mailing Address 5.Generator's Phone JJJ <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,Wl. Recycled Pursuant <br /> No. IVI-e volume to HSC 25143.2 <br /> A. _ -- YES-I Index I IX('2i I-H 2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 D'1' '1' 111ee111114.leyutrenienis Im <br /> Section 25.1 13 1) <br /> B. <br /> D. <br /> 1/i. 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 domestic regulations. <br /> I also recognise that in spite of product narne or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazardous waste reltulations.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 SU 14 by selecting,the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Represent tive/Print Name Siprlatu e Month Day Year <br /> 19.TrbnsporLer I Acknowledgemen't of Receipt of Materials <br /> Print/7ype Name Signature Month Day Year <br /> Transporter 2 Acknowledgement of Receipt of Materials — <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.Discrepancy Indication Section — -- -- <br /> 22.facility Ober ator:Cerdlication of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name Signature Month Day Year <br />