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Excluded Recyclable Material 1.Bill ofUd7* n 2. Document Number- 3. Dat <br /> Manifest USR 2018-000 1� <br /> 4.Gt:nt'ralor 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 typ. Volume to HSC 25143.2 <br /> A. 1'Es-lhider IISC?51.1 i <br /> Metal Shredder Aggregate- Excluded Recyclable Material 001 IYI' I' 111CCIIIIR 1equlreincnls fill <br /> tiecUou';11;U <br /> G. <br /> C. <br /> i <br /> D. <br /> i <br /> 14.Recycling Facility Name and Mailing Address 15. Facility Phone <br /> 1 <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 <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 mune 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 Irom <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 SU 14 by selecting;the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Representative/Print Name Signature Month Day Year <br /> ri a LA . \C(c' 1 �r C1 <br /> 19.Tran. orter 1 Acknowledgem n of eceipt of Material ' <br /> Print a Nam Si atur Month Day Year <br /> Transporter 2 cknowledgement of Receipt of Mat is <br /> Print/Type Name Pri /Type Name Month Day Year <br /> 21.Discrepancy Indication Section — <br /> 22.facility Oprt.ttor:Ct•rtilication 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 /> r'CA �U <br />