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Excluded Recyclable Material 1. Bill of Lading It 7Z Document Number 3.Date <br /> Manifest , USR 2018-000- <br /> � <br /> 4.Generator's Name and Mailing Address <br /> enerator's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 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 /> 8.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 /> A. <br /> N. TVI" Volume to HSC 25143,2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 11111 I Inder IISC 2i1.1;2 <br /> inecung tetluuemenls tin <br /> 'eclion 2141-1.0 <br /> B <br /> C. <br /> D. I <br /> 14.Recycling Facility Name and Mailing Address i <br /> 15. Facility Phone a <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,NV 89701 1 <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 /> rider 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:1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and areclassified, <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 51314 by selecting the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Representative/Print Name Signature <br /> Month Day Year----- <br /> 19.Trrinsportei 1 Ackl uwledgement of Receipt of Materials <br /> Print/Type Name Signature --- ---- <br /> -` - Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt o Materials <br /> Print/Type Name Print/Type Name <br /> Month Day Year <br /> 21.Discrepancy Indication Section <br /> 22.Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document <br /> Sigrtatur except as otherise wnoted on line 21 <br /> �'nnt/type Name <br /> t 1 r ' <br /> J; 1 - r; I`wl\ Month Day Year <br />