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Excluded Recyclable Material TBill of Lading h 2.Document Number 3. Date <br /> Manifest O USR 2018-000- I Z C1 <br /> 4eiGenerator's Name and Mailing Address 5.Generator's Phone L <br /> (4versal 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 /> ri. I i mr,pur tui 2 Company Name 9.Transporler's Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,wt. Recycled Pursuant <br /> Nu, Type Volume to 115C 25143.2 <br /> A. YES*Under I ISC'25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 11111 D'1' I 1' meeting requirements Ini <br /> Sect ion'_>413 9 <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 <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 recognize that in spite of product name or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <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 SD 14 by selecting the best methods that are available to me and that are economically practical. <br /> Generator or Authorized RepZ7L4—C(,_C_k_ <br /> /Print Name Signature �^ Month Day Year <br /> L l(,�uLG�c, L '� V L c� l 2 ► I �`� <br /> < < <br /> 111. ran:nnrtvr 1 Arlenowlerigemont of Receipt of Material <br /> Print/Type Name Signature i Month Day Year <br /> 20.Transporter 2 AEknow edgement of Receipt of Materials <br /> Print/Type Name _7ifit/Type Na Month Day Year <br /> 21. Discrepancy Indication Section <br /> 22. Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Ty a Name Signat a Month Day Year <br />