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Excluded Recyclable Material 1.[3111 of Lading It 2.Document Number �� 3.Date <br /> Manifest �� I USR 2018-000 •-?fit'�n <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 209-944-9555 <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 /> I.�: 1 i di Itipurler 1 t_umpany Name <br /> 9.1ransporter's Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> no, rym• Volume to HSC 25143.: <br /> - — — - - <br /> A. --- --1'1:x-lhwdcr Iltis' '-;I Is <br /> Metal Shredder Aggregate-Excluded Recyclable Material dill U'I' / 7' Illevillop n•tltrrrenrcnr"i^I <br /> I <br /> i <br /> 14. Recycling facility Name and Mailing Address 15.Facility Phone <br /> I Universal Service Recycling Nevada I.I.C.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 /> — ---------- - -- ------ <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 classdreri <br /> . <br /> racked,marked,labeled and are in all respects In proper condition for transport according to applicable domestic regulations. <br /> I dlsu 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 taking advantage of new technology and existing DISC i <br /> egulations to comply with Sit 14 by selecting the best methods that are available to me and that are economically practical. <br /> ;ienerator or Authorized Representative/Print Name Signatuc Month Day Year —) <br /> i C <br /> Pl. I ransporter 1 Acknowledgement of Receipt of Materials <br /> Print/Type Name Sign u Month Day Year _I <br /> ?6.Transporter 2 At6knowledgement of Receipt of at rials J <br /> i <br /> ;print/Type Name Print/Type Name Month Day Year � <br /> I <br /> �1. Discrepancy Indication Section — ------� <br /> I <br /> _ I <br /> racllity Operator.Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on rine 11 <br /> Print/type Namv SiRnatur � Month flay <br />