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Excluded'Recyclable Material 1.Dill of Lading 11 2. Document Number /� 3.Date <br /> Manifest `'1 PG 7 USR 2018-000- ��lJ Dat,( <br /> �p-o?Q <br /> 4.Generator's Name and Mailing Address 5.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-944-9555 <br /> i6.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 /> 1;. t rantiporter 1 l.urnpany Narne 9. 1 ransporter's hhono <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,wt Recycled Pursuant <br /> n... rvtM Volume to 11SC 21,14 i._ <br /> I t?ti14tJct l ltit "•I I t_ <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 1)TI/„ A.J I' <br /> 6P <br /> Iv suction 25.11;v <br /> i <br /> i <br /> ,14. Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.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 /> non-recyclable materials including foam rubber,Insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> 'Ander 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 /> I <br /> 18.Generaim s certificatlow I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are dassdied, <br /> packed,marked,labeled and arc in all respects In proper condition for transport according to applicable domestic regulations. <br /> I alsu recognize that in spite of product name or appearance,these commodities are being recycled and are wither non-hazardous or conditionally exempt from <br /> i azardous waste regulations.As the generator,lam making a good faith effort to minimize my waste and am taking advantage of new technology and existing D FSC <br /> regulations to comply with SB 14 by selecting the best methods that are available to me and that are economically practical. <br /> venerator or Authorized Representative/Print Name Signatu ay Month DYear <br /> _ �______ 3 -6�a� <br /> 19. 1 ransporter 1 Acknowledgement nowledgement of Receipt of Materials <br /> Print/lype Name Sign u Month Day Yom <br /> i �t - _ -- - -�-a� <br /> ?0.Transporter 2 A knowlec gement of Receipt ofat ials -- _- <br /> Prins/'type Name Print/Type Name Month Day Year <br /> 1.Discrepancy Indication Section ---- -' <br /> i <br /> I <br /> Z.raritily Operator:Certification of Receipt of Excluded Recyclable Materials by this Document,except as otherwise noted on line'1 <br /> I'rini/type Namv Signatu Mnnth nay Yr <br /> JJ ' <br />