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Excluded Recyclable Material 1.Dill of Lading it <br /> Manifest - <br /> 2. Document Number ,F 3 Date <br /> - - _ <br /> t USR 2018-000- i <br /> 4.Generator's Name and Mailing Address- --- <br /> �r � <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.Tran-- sporter's phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> Transporter 2 Company Name 209-944-9555 <br /> y J 'I ransporter''.Phone <br /> 10. US DOT Proper Shipping Name <br /> 11, Containers 12.Total Quantity 13.Unit,wt, Rocyrled Pur,u;rttt <br /> -- No. rvn, Volutin, !d <br /> A. Io HSC. 14:i_, <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 `�- t l`` I It'--��h <br /> 1)'1' <br /> �__ f ntccnn�rcqunrtncnr. ,,, <br /> E. '�"Ololl 2i4I t•r <br /> Iw <br /> I D. <br /> i <br /> 174. Rec�Facility Name and Mailing Address <br /> Universal Service Recycling Nevada LLC. 5855 Sheep Dr.Carson City,NV 89701 15. Facility Phon(* 4; <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 -- <br /> on-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped <br /> under the provisions of subdivision(d)of Section 25143.2. plashes,and <br /> aggregate is an excluded Irecyclable material 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 /> I&Generators,la elect un:I hereby declare that the rontents of this consignment are fully and accurately described above by propershq�ping nyrr„ and�p rr.ked marked,Itbeled and are in all respects to proper condition for transport according to applicable domestic regulationro ; - -_-- <br /> isn rr cognbc drat in stole of product name or a r i are rI milwa, <br /> j halm dous waste regulations.As the tie nc.rator,i am making a good faith effort to minimize mywaste and am taking advanta�c ul ne <br /> ppearmtce,[hese commodities are being recycled and are either nun-hazardous or conditionally exempt boor <br /> I i r rulohom to comply with SB 14 by selecting the best methods that are available tome and that are economically practical. <br /> (. w technology and existing DTSr. <br /> (xnerafor or Authorized Representative Print Nar <br /> Month Day <br /> _ t 1 t _•-�-, l ��?� ar <br /> 11. ------ <br /> Ti.ul.itot let i At hn wietll;enurnt of Receipt Of Malrorial� <br /> - - <br /> IPrirtt/TVpe <br /> signature <br /> j Month Dal' Year - <br /> U transporter 2 Acknowledgement of Receipt of Materials - <br /> - - - <br /> -- - - <br /> Pritrt/TypeName __T, <br /> - _-- <br /> Print/Type Nance ----- _ <br /> IMonth DaV lrnr i <br /> - — <br /> I.'I. Discrepancy Indication-Section--Secec tion__ <br /> — ---� <br /> I <br /> ' i•tnlily t7pr,ral<,t;C r•rtitication of Rcxetpt of f=xcludecl Recyclable Materialt;by fhre Docunu <br /> it lull/ type Namn nt except,i;W.hevwi,e'nutt,ti on lute,.'.I <br /> �ti;natU c --- - <br /> f.r - ` Month Day yen -- _ <br />