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Excluded Recyclable Material 1.Bill of Lading It 2. Document Number f— 3. Date <br /> Manifest �Q )Il j USR 2018-000-41> �— I g'Z, <br /> 4.Generator's Name and Mailing Address 5.Generator's Phone <br /> Universal Service Recycling,Inc,3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S. EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> S.Tl,ntsl)u1 Lel 2 Company Ndn1e 9.Transporter'-.Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wl. Recycled Pursuant <br /> No. typL Volume to HSC 25143.2 <br /> A. VES-Under I ISC 25143' <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 IYI' I' meeting requirements Kir <br /> l Section 25.113.0 <br /> B. <br /> C. <br /> D. <br /> 14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City,NV 89701 209-944-9555 <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 /> 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 heroby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> picked,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,I am making a good faith effort to minimize my waste and am taking advantage of new technology and existing DISC <br /> regulations to cornply 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 Month Day Year <br /> 19. Ft di sNui let Aclvruwledgentent of RcceipL of Materials <br /> Print/Type Name Sig arurc' Month Day Year <br /> I i Lrl KCL' <br /> -' �-' <br /> 20.Transporter 2 Acknowledgement of Receipt of�te"rials <br /> Print/Type Name Print/ e Name 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 2.1 <br /> Print/Type Name Signa <br /> r° --- ---- <br /> g \` Month Day Year <br />