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Excluded Recyclable Material 1.Bill of Lading it 2.Document Number <br /> Manifest 3.Date <br /> USR 2018-000- � <br /> 4,tienerator's Name and Mailing Address <br /> 5.Generator's one <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 /> 8.Tramporter 2 Company Name <br /> 9.Transporter's Phone <br /> 10. US OOT Proper Shipping Name <br /> 11. Containers 12.Total quantity 13.Unit,Wt. Recycled Pursuant <br /> TVw Volume to HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material uu l D I 1'I?ti-I lnder I IK'?5143' <br /> 'I' Heeling rr(luirentenls lin <br /> ___ __ Sevihm 25413 n <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 /> ixture 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 name 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 or appearance,these commodities are being recycled and are either nonhazardous 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 SB 14 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 <br /> Day Year <br /> 17.11a11aNu1tei 1 ALlaruwledgement of Receipt of Materials <br /> Print/Type Name Signature <br /> Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt of!Pferials /( ) <br /> Print/Type Name Print <br /> /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 except as otherwise noted on line 21 <br /> Print/Tyre Name <br /> Signatur Month Day `Year <br /> . 3 , <br />