Laserfiche WebLink
Excluded Recyclable Material 1.Bill of Lading It 2.Document Number rr � r N <br /> Date <br /> Manifest �O �`� USR 2018-000-`f S� I D C) <br /> Ge.Wrates 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's Phone <br /> Universal Service Recycling,Inc.3200 S. EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> S.Ti an�.pui let 2 Company Name 0.Transporter'-,Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> tm. fyt,, Volume to HSC 25143.2 <br /> A. YES-Under I IS('2i 1,13.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT .1, meeting rctluitcinents kir <br /> Section 25-113 <br /> B. <br /> C. <br /> D. <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 /> non-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 /> 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: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 aie 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 non-hazardous 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 S13 14 by selecting the best methods that are available to me and that are economically practical. <br /> i <br /> Generator or Authorized Representative/Print Name Signature Month Day Year <br /> 17. 11 di spui let AcLnuwledgenienl of Receipt of Materials <br /> Print/Ty��p--e--Name _ SiggaYure � Month Day Year <br /> 20.Transporter 2 Acknowledgement of Receipt oftLrial <br /> Print/Type NamePrint/ re Name Month Day Year <br /> 21. Discrepancy Indication Section — <br /> 22.Facility Operator:Certification of Receipt of Excluded Rec cl—ab le Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name A 1_ Signature Month Day Year <br /> 2—C4 <br />