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excluded Recyclable Material 1.Bill of lading# 1 ' 2.Document Number L �/�y� 3.Date <br /> Manifest q`f� USR 2018-000- -i1.<l — -� <br /> 4.Generator's Name and Mailing Address S.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-95SS <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-944-9SSS <br /> 8.Transporter 2 Company Name 9.Transporter's Phone <br /> 10.US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13,Unit,Wt. Recycled Pursuant <br /> NO, Type Volume to HSC 25143.2 <br /> A. FS-Under HSC 25143 2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT PriLding requirements i'or <br /> lSection 25413 u <br /> B. <br /> C. <br /> D. <br /> 14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.SBSS Sheep Dr.Carson City,NV 89701 209.9449555 <br /> 16.Additional Description for Material Listed Above <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 /> oder 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:l 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 non-hazardous or conditionally exempt from <br /> hazardous waste regulations.As the generator,t am making a good faith effort to minimize mywaste and am taking advantage of new technology and existing DTSC <br /> regulations to comply with 5814 by selecting the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Representative/Print Na a Signature Month Day Year <br /> �rO�YYIY�n 1�,1 a- 1 O 6xu <br /> 19.Transporter i Ackno ledgement of Receipt of Materials <br /> Print/Type Name ' Signature ` Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt of Materials <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.Discrepancy Indication Section <br /> 22.Facility Operator:Certification of Receipt of Excluded Recyclable Materials bx this Document except as otherwise noted on line 21 <br /> Print/Type Name Signatu Month Day Year <br />