Laserfiche WebLink
VExcluded Recyclable Material 1. [sill of Lading It 2.Document Number <br /> nifest II.' 3.Date <br /> US <br /> 2018-000-_ � ` . <br /> enerator's Name and Mailing Address — _' Z^2 <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.Transporter's Phone --- <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> E.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 /> n Tyr"' Volume to NSC 251 13.Z <br /> A. <br /> Metal Shredder Aggregate-Excluded Recyclable Material pp 1p•I• _ 1'I'a-I hider I Itis'>;1 l.; <br /> Illecling Iequilenlclll`fill <br /> l3. Scebun 254 I S 1) <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 /> 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 sonic 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 orappearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazardous waste regulations.As the generator,I am slaking a good faith effort to minimize my waste and am taking advantage of new technuluI;Y:uad existing UTSC <br /> regulations to comply with SB 14 by selecting the best methods that are available to me and that are economicall l <br /> y practical. <br /> Generator or Authorized Representative/Print Name Signature —— <br /> M _ <br /> onth Day Year <br /> ���V CI 1 1't'��-� --- <br /> M.Tianspol t(,, 1 A[.knuwiedgement of Receipt of <br /> �C1111 f it Materials <br /> Print/Type Name -- <br /> Signature — ---_--" -- <br /> Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt of Materials <br /> Print Type Name <br /> 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 Docunla�nt except as otherwise holed on Ilse 21 <br /> I'l lm/type Name Signatur <br /> ^ Month Day Year <br />