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Exfluded,"clable Material 1.BIII of lading# 2.Document Number [q 3.Date <br /> Manifest O USR2018-000- �� I 2;)o DO <br /> 14.Generator's Name and Mailing Address 5.Generator's Phone <br /> I <br /> i Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> !6.Transporter 1 Company Name 7.Transporter's Phone <br /> IUniversal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 18. Transporter l Company Name 9.Transporter's Phone <br /> 10. US DOT Proper Shipping Name 31. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> • type Volume to HSC 25143.2 <br /> i <br /> ;A• V Es-tinder IEC 25143 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 D'If ncelmi;rctpnremems kir <br /> I "( <br /> Section 2541.14 <br /> B. --- <br /> i <br /> (f <br /> ID. <br /> i <br /> 14.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> I <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 recydable 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 /> oder the provisions of subdMsfon(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 <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 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 takingadvantage 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 /> Generatoror Authorized Representative/Print Name Signa Month Day Year <br /> Ly. I ransporter 1 Acknowledgement of Receipt of Materials - --- - - <br /> Print/Type Name Sign u Month Day Year <br /> ;Nr�ansporter3 �a© acf 2 of Receipt of at ails <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.Discrepancy Indication Section <br /> -2.raciiity Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name Signature Month Day Year <br /> a <br />