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FGenerator's <br /> cyclable MateTia". ill of Lading I1 — _ <br /> �gJ t ���ntNumber / 3.Date <br /> �T USR 2018-000-36e 1- 3-20_ ��� <br /> Name and Mailing Address --— IS.Generator's Phonervice Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> 6.Transporter 1 Company Name 209-944-9555 <br /> 7. I ransporter's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 <br /> 8.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 /> " Volume <br /> A. to HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 11011'I?ti•tinder IIS('23 143 2 <br /> meeting requuemenis lin i <br /> Section 254 1.1.,) <br /> [D..Recycling Facility Name and Mailing Address <br /> 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,NV 89701 <br /> 16.Additional Description for Material Listed Above 208-944-9555 <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 /> nder the provisions of subdivision(d)of Section 25143.2. <br /> kN <br /> pecial Handling Instructions <br /> pecial handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material <br /> 24 Hr.209-751-9946 for Environmental Health and Safety Manager <br /> enerators Certification:I hereby declare that the contents of this consignment are fully and accurately described above b,marked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations.proper stripping name and are classified, <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 DISC <br /> regulations to comply with So 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 Day Year-- <br /> auc VY <br /> _ <br /> 19.Tr.msporter 1 Acknowledgement of Receipt of Materials -- I z_o <br /> Print/Type Name Signat_u_re <br /> -- <br /> ` Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt o-i"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 D <br /> V11111/ly a Name Signat ocument except as otherwise noted on line 21 <br /> r \ _ <br /> h"n`J►) <br /> Month Day Year <br />