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jExciuded.Recyclable Materialof Lading# 2.Document Number t i 3.Dat <br /> I M61fest ri� <br /> v USR 2018-OW-0 3 <br /> W 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 /> 16.Transporter 1 Company Name 7.Transporter's Phone <br /> IUniversal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> i8. 1 ransporter 2 Company Name 9.Transporter's Phone <br /> r <br /> i 10. US DOT Proper Shipping Name 21. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> No. type Volume to HSC 25143.2 <br /> 7A. Inti-t Indcr I ISC'_514 i 2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 D7' 7 netting rktituremenu for <br /> Section 2541.1 4 <br /> i <br /> Ir_ <br /> i <br /> t <br /> ID. <br /> t i <br /> i <br /> 114.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LI.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 /> 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 /> Nospecial 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 arejn 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 goad 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 /> 19.1 ransporter 1 Acknowledgement of Receipt of Materials - <br /> Print/Type Name Sign u Month Day Year <br /> _ .Transporter 2 A nowle gement of Receipt of MattrI411i <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.Discrepancy Indication Section <br /> 12.Facility operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name , ' 1 Signature Month Day Year <br /> I IJ�.J r t Li <br /> i ("i U_ <br /> k <br /> t <br />