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Excluded Recyclable Material 1.Bill of Lading# � 2.Document Number / 3.Date <br /> Manifest �C.t.(JZ USR 2018-000-��`�' <br /> 14.Generator's Name and Mailing Address S.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> i Universal Service Recycling,Inc.3200 S.Ei Dorado St.Stockton,CA 95206 209-944-9555 <br /> X. 1 ransporter l company Name 9.Transporter's Phone <br /> i <br /> 10.US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,wt. Recycled Pursuant <br /> No. 1VPe volume to HSC 25143.2 <br /> :A• VEs-ilnder IIsV 251.{; <br /> i Metal Shredder Aggregate-Excluded Recyclable Material 001 WF f nimling requirements kir <br /> 'union 25413 1) <br /> B. ------ <br /> I <br /> !C, <br /> i0. <br /> I <br /> I14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,NV 89701 209-9449555 <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 /> X17.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 orappearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazardous waste regulations.As the generator,i am making agood 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 /> Generator or Authorized Representative/Print Name Signa Month Day Year <br /> 20 <br /> 19. 1 ransporter 1 Acknowledgement of Receipt or Materials <br /> Print/Type Name Sign u Month Day Year <br /> -- <br /> .Transporter 2 A nowle gement of Receipt of at als <br /> Print/Type Name Print/Type Name Month Day Year <br /> I <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 /> I Pint/Ty a Name Signature Month Day year <br />