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Excluded Recyclable Material 1.Bill of Lading If 2.Document Number :Mw� <br /> Manifest 0 USR 201"00%C2L <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 /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-944-9555 <br /> 8.Transporter 2 Company Name 9.Transporter's Phone <br /> 10. US DOT Proper Shipping Name 11. Containers 12.Total quantity 13.Unit,Wt. Recycled Pursuant <br /> No. Type Volume to HSC 25143.2 <br /> A. <br /> Metal Shredder Aggregate-Excluded Recyclable Material 00I DT �-Under_HSC nts for 1 5 '[' meeting requirements for <br /> 1 ection 25413.9 <br /> B. <br /> C, <br /> D. <br /> 14. 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-rerycI bie materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate Is an excluded recyclable material <br /> nder the provisions of subdivision{d}of Section 25148.2. <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 /> hazardous waste regulations.As the generator,I am making a good faith effort to minimize mywaste and am taking advantage of new technology and existing DTSC <br /> regulations to comply with so 14 by selecting the best methods that are available to me and that are economically practical. <br /> Geen``eratororAuthorized Representative/Print Name Signature Month Day Year <br /> co <br /> 19.Transporter 1 Acknowledgement of Receipt of VM e <br /> Print/Type Name Si ture Month Day Year <br /> WjMam I, r . - <br /> 20.Transporter 2 A knowledgement of Receipt of Materials <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21. Discrepancy Indication Section <br /> 22.Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> print/Type Name Signature <br /> Month Day Year <br />