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(Excluded Recyclable Material 1.Bill of Lading it 7-- <br /> Document Number 3.Date <br /> USR 2018-000- �� ?j • 23 -Z(J <br /> hManik rt <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 209-9449555 <br /> 16.Transporter 1 Company Name 7.Transporter's Phone <br /> I Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> IS. 1 ransporter L Company Name 9.Transporter's Phone <br /> I <br /> i 10.US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> NO. type Volume to HSG 25143.2 <br /> 'A. li1-tlntkr IISC 2?14: <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT1 1' ncome. um <br /> rLqueents Ibr <br /> i 2 ` Section 25413 N <br /> t <br /> I <br /> ID. <br /> I <br /> 114.Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LLC.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 /> oder 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 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 non-hazardous or conditionally exempt from <br /> nazardous 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 /> 3 -Z3— 2G <br /> 19. 1 ransporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name Sign u Month Day Year <br /> t 3 w 3 -23-2-0 <br /> .Transporter 2 A nowle gement of Receipt of at ais <br /> Print/Type Name Print/Type Name Month Day Year <br /> a n <br /> 21.Discrepancy Indication Section <br /> 12.racility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on iine 21 <br /> Print/Type Name SignaturMonth Day Year <br /> W"AkLJ 3 <br />