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Excluded Recyclable Material 1. Dill of Lading It 2. Document NumberI I �� I Date l <br /> Manifost 70 ' 0 ) USR 2018-000- `I L <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 /> 6.Transporter 1 Company Name 7.Transporter'—Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> 8.Ti wispoi lei 2 Cumpdny Name 9.Transporter'-.Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.unit,Wt. Recycled Pursuant <br /> No [VI" Volume to HSC 25143.2 <br /> A. YES-lln(ler I ISC25143.' <br /> Metal Shredder Aggregate-Excluded Recyclable Material (1111 D"I' -��y -� I' meeting requirements li)r <br /> f Section 25413.4) <br /> C — <br /> 74. 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 /> on-recyclable materials including foam rubber,Insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> ride <br /> 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:1 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 nonhazardous 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 /> Generator or Authorized Representative/Print Name Signature <br /> rth Day Year <br /> �� ► i>>�. ��t u�r�!(' �. � <br /> 19.1 tLnsNut lei VALkl iuvvledgeilent of Receipt of Materials _ <br /> Print/Type Name � z _ <br /> sig a re Month Day Year <br /> Zs <br /> 20.Transporter 2 A knowledgement of Receipt of tLsrial — <br /> Print/Type Name `' Print/ e Name <br /> 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 Signatu <br /> Month Day Year <br /> PYA C,J �. <br />