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Excluded Recyclable Material 1.Bill of Ladin 2. Document Number /�l 3. Da e <br /> ManifestU 149 USR 2018-000- (� <br /> 4,Gc ner�rlo`c;Name and Mailing Address 5.Gunerilor'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 /> R.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, IVI'L Volume to HSC 25143.2 <br /> Metal Shredder Aggregate- Excluded Recyclable Material 001 1) �LI 1' ncennl:legwremcm+Gn <br /> Section 25.11;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 /> on-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> Inder 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 realgnIfe that in spite of product name or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazardum waste reguldlions.As the generator,I am making a good faith effort to minimize my waste and am taking advantage of new techoolugy and existing DTSC <br /> regulations to comply with SB 14 by selectinl;the best methods that are available to me and that are economically practical. <br /> Gen rator or Authorized Repiese ative/Plint Name Sign tore pit Month Day Year <br /> '/ <br /> Ar <br /> � _4 <br /> 19.T nsporter 1 Acknowledgement of Receipt of Mated Is - -- <br /> I'rint/ Name - - Sign -r — Month Day Year <br /> 20.Transporter 2 Ac nowledgemenl•of Receipt olI I -- — <br /> print/Type Name Pr' /Type Name Month Day year <br /> 21. Discrepancy Indication Section - — — - - -- — <br /> 22.Facility Opel dor:Cor lilication of Receipt of Excluded Recyclable Materials by this Document except.as otherwise noted on line 21 <br /> Pl int/Ty1pe Narne f \ 1j Signatur Month Day Year <br /> V�J r 1 �4 <br />