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Excluded Recyclable Material 1.Oill of Lading 11 2. Document Number 3.Date <br /> Manifest q I USR 2018-000-yy� <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 /> I6.Transporter 1 Company Name 7.Transporter's Phone <br /> iUniversal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 _ 209-944-9555 <br /> ;s. I I are.porter 1 Cornpany Name 9.17ansporter's Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> N,.. iyrK Volume to HSC 2%1,13.21 <br /> Metal Shredder Aggregate-Excluded Recyclable Material Ilii I lyl' 1' "cct"'g rc(lutrcoic"h i^' <br /> Sect ion 25.11.;') <br /> I>. <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 /> ion-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> coder the provisions of subdivision(d)of Section 25143.2. <br /> 17.Special Handling Instructions j <br /> No special handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material i <br /> 24 Hr.209-751-9946 for Environmental Health and Safety Manager <br /> I <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 rtasihed, j <br /> packed,marked,labeled and are 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 either nonhazardous or conditionally exempt from <br /> hazardous waste regulations.As the generator,lain making a good faith effort to minimize my waste and am taking advantage of new technology and existing t)[Sc <br /> i <br /> egulotions to comply with SU 14 by selecting the best methods that are available to me and that are economically practical <br /> 5enerator or Authorized Representative/Print Name Signatu[ Month Day Year <br /> — -- <br /> Ly. I ransporter 1 Acknowledgement of Receipt of Materials <br /> I <br /> i,-Tint/Type Name Sign u Month Day Year <br /> 20.Transporter 2 A knowle gement of Receipt of Maierrials – — <br /> I,rint/Type Name Print/Type Name Month Day Year <br /> I <br /> 11. Discrepancy Indication Section —� <br /> t <br /> I <br /> I <br /> racility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line'1 <br /> Print/type flame Signator ` Month , nay Year <br />