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Excluded Recyclable Material 1.Bill of Lading It 2.Document Number �C�] 3. Da e <br /> ManifestUZ(A USR 2018-000-.1�L 12 Z�q_ <br /> 4.Gener.Ylor's Name and Mailing Address 5.Generator's Phone J <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 31. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> No. IV", Volume to HSC 25143.2 <br /> k YES-Under I IS(('25143 2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material IIII I D'I ' I mceung rcyuuenrenls lot <br /> Section 25-1114) <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 /> oder 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.Gere ralors Certification:I hereby declare that the contents of this consignment are fully and accurately described above by proper siupprng name and are classibed, <br /> packed,marked,labeled mid are in all respects in proper condition for transport according to applicable domestic regulations. <br /> I also recognize that in-.pile of product name or appearance,these commodities are being recycled and are either non-hazardous or condrtronally exempt front <br /> ha2attluus wdste regulations.As the generator,I am making a good faith effort to minimize my waste and am taking advantage of new technology dnd 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 Represen live/Prinoame Signatur I - Month Day car <br /> 19. ransporter 1 Acknowledgement of Receipt of Mat a s <br /> '�- Il <br /> Print//1 )eName S',nat re Month Day Year <br /> 2 .Transport r2 cknowledgement of Receipt of M i I <br /> Print/Type Name Int/Type Name Month Day Year <br /> 21. Discrepancy Indication Section - - —- -— <br /> 22.facility Olietalor:0--r ilication 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 /> � , �'J U - <br /> Z2 tq <br />