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r-xcrttaea Recyclable Material 1. Bill of Lading 11 <br /> Manifest / 2. Document Number <br /> 4.Generator's Name and Mailing Address (Cj USR 2018_000- �JL 3•Date- <br /> 4. <br /> ate l <br /> 5.Generator's Phone - -- <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 <br /> 6.Transporter 1 Company Name 209-944-9555 <br /> 7.Transporter's Phone -`---- <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> S.Transporter 2 Company Name 209-944-9555 <br /> -- -9.Transpot tet',Phone <br /> 10. US DOT Proper Shipping Name _ <br /> 11. Containers 12.Total Quantity 13.Unit,Wt. (tecychsl I'urwanl -- <br /> Nu. rVlk' <br /> A. volume to HSC2;14a.-I <br /> Metal Shredder Aggregate-Excluded Recyclable Material <br /> 0111 I)'h 1'I(ti-Ilndcl 115('`i11: i <br /> IIRT1111:'It'lllllll'llll'lllti 11N <br /> B• �?�J �rcl Ion '..�,I I i 4 <br /> C. _— <br /> D. <br /> 14.Recycling Facility Name and Mailing Address <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson Ci 15.Facility Phone —� <br /> 16.Additional Description for Material Listed Above p City,NV 89701 <br /> fixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including 209-944-9555 `— - <br /> on-recyclable materials Including foam rubber,insulation materials and entra(ned soil and grit.Shipped ` <br /> nder the provisions of subdivision(d)of Section 25143.2. ng recyclable metals,recyclable plastics,and <br /> Aped 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 Certification;I hereby declare That the contents of this consignment are <br /> packed.(narked,labeled and are in all respects in proper condition for transport according rto accurately described above b <br /> I also recognize that In spite of product name oral proper shipping Hanle❑nd an',.I,r,,,1,,,,l <br /> pplicable domestic regulations. <br /> epulalazal tion waste reg witons./1s the generator,I am making a good faith effort to minimize my wasteand am takln Advantapearance,these commodities are being recycled and are either non-harrrdous or conditionally exemptIruu, <br /> 1,, <br /> egulations to comply with 5[314 by selecting the best methods that are available to me and that are economically practical. I <br /> g advantage of new lechnolo; and emsling DTSC <br /> __ i Y: <br /> Generator or Auth i ezro d Representative/Print Name Signatur <br /> I <br /> t^' Month ' <br /> �}C16 DAY Y,1.11 --I <br /> 19.Trnnpol lel, A(.hlluwlt dgernent of Receipt nl Matnrial� - <br /> Print/ <br /> signature - <br /> - Month Day Yea <br /> � <br /> r <br /> 20. I7ansporter 2 Acknowledgement of Receipt of Materials <br /> -- --- I <br /> Print/Type Name <br /> Print/Type Name _ <br /> IYlunth D-ty Year --� <br /> 21.Discrepancy Indication Section <br /> ??.Facility OpNrator:Certification of Receipt of Excluded Ree -`-- <br /> clable <br /> •,,,; � __ Y Materials <br /> t/type Name _ by Ch1S I)Ocwnc'nl oxcrpl.I;ulhcl wi�r <br /> Signatu a —�� nuu 11 nn Ino'.)I <br /> - <br /> C <br />