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Excluded Recyclable Material 1.Hill of Lading fi 2.Document Number 3.Date !Manifest USR 2018-000- Q2_3 ,??5C:_' ;,1.Generator's Name and Mailing Address 5.Generator's Phone (Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 5.Transporter 1 Company Name 7.Transporter'-;Phone (Universal Service Recycling,Inc.3200 S.EI Dorado 5t.Stockton,CA 95206 209-944-9555 X. I i my porter 1 company Name 9. t ransporter':Phnno (10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unil,wt. Recycled Pursuant r+ +vfM V011unP to HSC 25 111 1.2 .,. -- ---- ----- --- ------------— - -- --- lndc+lltit• Metal Shredder/Aggregate-Excluded Recyclable Materiala flu I U'1' �� '1' nce,mg requu.�nrcm'.i,„CIL txnivn 2541 t r i j 14. Recycling Facility Name and Mailing Address 15.Facility Phone (Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City, NV 89701 209-944-9555 16.Additional Description for Material Listed Above - ------ --- Mixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and non-recyclable materials including foam rubber,Insulation materials rmd entrained soil antirit.Shipped pped aggregate is an excluded recyclable material tinder the provisions of subdivision(d)of Section 25143.2. 17.Special Handling Instructions — --- - — - - - No special handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material 24 Hr.209-751-9946 for Environmental Health and Safety Manager 18.GenNrators Certification:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping n;imr-awl are d;wilwd, backed,marked,labeled and are in all respects in proper condition for transport according to applicable:domestic regulations. I also recognize that in spite of product name or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt trop+ nazardous waste regulations./\s the generator,I am making a good faith effort to minimize my waste and am takint;advantage of new technology. ,d existing D f St. j regulauons 10 comply with 5l1 14 by selecting the best methods that are available to me and that are economically practical. venerator or Authorized Representativel/Print Name Signatur Month Day Yea, 1y. I ransporler 1 Acknowledgement of Receipt of Materials j Print/Type Name Sign u /. Month Day Year 1 20.Transporter 2 A knowledgement of Receipt of Mat Pals — -- - i Print/Type Name Print/Type Name Month Day Year 1. Discrepancy Indication Section -- I I r,lcibly operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise Holed on line 21 1rint/ I yhe Name Slf;m[ur :-- Month Day