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i <br /> Excluded Recyclable Material 1.Bill of Lading 11DOCUment� Z. Number r '�7 - 3. Date <br /> 'Manifest �0 z^ USR 2018-000- 3-s o-x ! <br /> 4.Generator's Name and Mailing Address 5.Generator's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-944-9555 <br /> 116.Transporter 1 Company Name 7.Transporter's Phone <br /> I Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> x. I I aii%l1o1[w !t-ornpany Name 9. 1 ransportoO.Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit.Wl. Rvcyclecl Pursuant <br /> u... type volume to HSC 2514 1.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 11101 IYI' h I' nu�trrrp.r�glrrr �n�rr•W1 <br /> 9V,� tiituun`>•Ii i v <br /> I . <br /> ! <br /> I <br /> 14. Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.5855 Sheep Dr.Carson City,IVV 89701 209-944-9555 <br /> 116.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 /> coder 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 /> I <br /> 18.Generators Certification:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping mime and are cfassrfied, <br /> tjacked,marked,labeled and aro 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 nun-hazardous or cunditiundliy exrmpl hoar <br /> iiazanluus waste regulations.As the generator,I am making a good faith effort to minimize my waste and am taking advantage of new technology.cod exrstlnt U fSC <br /> egulauons io comply with SD 14 by selecting the best methods that are available tome and that are economically practical, <br /> generator or,Authorized Representative/Print Name Signatur LIz— Month Day year -� <br /> Ly. I ransporter 1 Acknowledgement of Receipt of Materials f `� <br /> Print/Type Name Sign u Month Day Year -- <br /> �0.Transporter 2 Acknowledgement of Receipt of Mat ials - — —� <br /> I <br /> ,11111/1 ype Name Print/Type Name Month Day Year 1 <br /> �1. Discrepancy Indication Section -- ---- -I <br /> i <br /> I <br /> i <br /> ,It ility Operaler:Cei lilication of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 11 I <br /> Piini/Iype Name Signal ire Month nay yr-1:11- <br /> - -- <br />