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I(,xciuded Recyclable Material 1.Bill of lading 0 j ('� 12.Document Number /�� 3.Date <br /> Mapifest (`ten "1�ow USR2018-000- "i a$' d <br /> 14.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 /> 16.Transporter 1 Company Name 7.Transporter's Phone �.. <br /> I Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> S. I ransparter 1 Company Name 9.Transporter's Phone <br /> !10.US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> i NO. type Volume to HSC 25143.2 <br /> i <br /> A Ids-t hiJcr I ltit''_5(.1, <br /> j Metal Shredder Aggregate-Excluded Recyclable Material 001 DT (` I' »coon 5413cmcn�s n <br /> Section 25413 y <br /> B. <br /> I <br /> IC <br /> D. <br /> i <br /> I14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <br /> '16.Additional Description for Material Listed Above <br /> fixture 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 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,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 /> I <br /> i Generator or Authorized Representative/Print Name Signa Month Day Year <br /> 19. 1 ransporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name Sign U Month Day Year <br /> oau i <br /> Transporter 2 A Howie gement of Receipt of atlei4fs <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 by this Document except as otherwise noted on line 21 <br /> Print/Type Name Signatur Month Day Year <br /> 1'Ji <br />