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Xxcludrio Recyclable Material 1.Blli of Lading# 2.Document Number 3.Date <br /> IMa,nifest 035USR2018-000-L474—•Z-2 <br /> 14 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 /> !Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-9449555 <br /> is. I ransporter 1 Company Name 9.Transporter's Phone <br /> 110. US DOT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,Wt. Recycled Pursuant <br /> Nn. We Volume to HSC 25143.2 <br /> ,A• V[Is-I Inilcf I Itis•_'St•I,t <br /> j Metal Shredder Aggregate-Excluded Recyclable Material 001 DT I nccung rcquncments Ihr <br /> �. vcnon 254 13 9 <br /> B. <br /> i D. <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 /> under the provisions of subdivision(d)of Section 25143.2. l <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 orconditionally exempt from <br /> hazardous waste regulations.As the generator,I am making a good faith effort to minimize my waste and am takingadvantage of new technology and existing DISC <br /> regulations to comply with 51314 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 /> l(m)-n�. 'n!_.i��a r r(A--� <br /> i 4- 2�- � <br /> 19. 1 ransporter 1 Acknowledgement of Receipt of Materials --- <br /> Print/Type Name Sign u Month Day Year <br /> ffig�&AL H - -2 <br /> ?6.Transporter 2 A nowle gement of Receipt of at als - <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21,Discrepancy Indication Section <br /> 32.Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name Signatur Month Day - Year <br />