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txcluded Recyclable Material 1. Bill of Lading If <br /> Manifest ; 2.Document Number <br /> USR 2018_000-M <br /> 4.Generator's Name and Mailing Address <br /> 5.Generator's Phone '-- <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> 6.Transporter 1 Company Name 209-944-9555 <br /> 7.Transpor er's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> 8.Transporter 2 Company Name 209-944-9555 <br /> 9.Transporter's Phone -- ' <br /> 10, US DOT Proper Shipping Name <br /> 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> uo. <br /> TV[,, <br /> volume to HSC 25I113.21 <br /> Metal Shredder Aggregate-Excluded Recyclable Material Op 1 _ 1'Fs-I Indcr nsc' 1.l <br /> m ; <br /> i)'1' ceung rerluucmcnJill <br /> li <br /> i' <br /> B. ticchun?jl I{ r <br /> C. <br /> D. <br /> 14.Recycling Facility Name and Mailing Address <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr. Carson City, NV 89701 15. Facility Phone <br /> 16.Additional Description for Material Listed Above 205-944-9555 <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 <br /> under the provisions of subdivision(d)of Section 25143.2. <br /> aggregate is an excluded recyclable material <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 Cerlification:I hereby declare that the contents of this consignment are fully and accurately described above by proper Shipp <br /> packed,marked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations. <br /> I also recognise lilac in spite of product name ora inf;name:md are classified, <br /> hazard <br /> appearance,a g these commodities are being recycled and are either nonhazardous or conditionally exempt from <br /> regulations to cus tomply with SD 14 by electing the besttions.As tile generator,I ani methods that aood lth effort to re available to me'ze and that are aeon <br /> y waste and am taking advantage ul new technulolSyand existing DTSC <br /> economically practical. <br /> Generator or Authorized Representative/Print Name Signature�}-� <br /> `)n V_ Month D; Year------ <br /> 19.Transporter l- cknowledgement of Receipt of Malprialti <br /> Print/Typr Name — --- <br /> signature ----- ------- <br /> - Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt of Materials I �� <br /> Print/Type Name <br /> Print/Type Name <br /> Month Day Year <br /> 21.Discrepancy IndicationSection <br /> Z2.Facility Operator:Certification of Receipt of Exciuded Recyclable Materiais by this Document except as olhcrwi <br /> I'nnt/lyp�— e Name— - ---- se noted on line 21 <br /> Signatur <br /> 1 <br /> f Month Day Year <br /> t <br />