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Excluded Recyclable Material 1. [sill of Lading If 2. Document Number � <br /> Manifest Z( 3.Date I <br /> iU' )l(� USR 2018-000- <br /> r <br /> 018-000- 1 ,C� <br /> 4.venerator's Name and Mailing Address <br /> 5.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S. EI Dorado St.Stockton,CA 95206 <br /> 209-944-9555 <br /> 6.Transporter 1 Company Name <br /> 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> 209-944-9555 <br /> R.Transporter 2 Company Name <br /> 9.Transporter's Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total quantity 13,Unit,Wt. Recycled Pursuant <br /> Nu. Ivy". volume to FISC 2514j.-, <br /> A. <br /> Metal Shredder Aggregate-Excluded Recyclable Material ppl I)1 _ ells-I Inrh-r I IS C 2 114; <br /> I I V nrccuup rcqunemcnl'i lin <br /> -=�- ticchuu]i•I 13 r <br /> Q. <br /> C. <br /> D. <br /> 14. Recycling Facility Name and Mailing Address <br /> 15. Facility Phone <br /> Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City, NV 89701 <br /> 16.Additional Description for Material Listed Above 209-944-9555 <br /> Mixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> on-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 <br /> packed,marked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations. name and are cl,i•sllled, <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 icon, <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 bTSC <br /> regulations to comply with S©14 by selecting the best methods that are available to me and that are economically y practical. <br /> Generator or Authorized Representat t Name Signature -Day__DaY Year <br /> 1D.TlantiporLei 1 Fichnuwletit;emen[of Receipt of MatPrialti ---- — I Z' G v Cl <br /> Print FVPa Name <br /> Signature — _ <br /> --- —Month Day Year-- – --– <br /> 20.l ran sporter 2 Acknowledgement of Receipt of fVlaterials <br /> Print/Type Name Print/Type Name <br /> Month Day Year <br /> 21. Discrepancy Indication Section <br /> 22. Facility Operator:Ce rtification of Receipt of Excluded Recyclable Materials by this Do <br /> ype Name cument except as other witie noted on line 21 <br /> Signat <br /> Month <br /> Day Year <br />