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Exclud Recyclable Material 1.Bill of Lading _ 2.Document Number 3.Date <br /> Manifest �� $ USR 2018-000-� 1 pl(y p. I <br /> Excluded <br /> 4.Generator's Name and Mailing Address 15.Generator's Phone u <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 /> 8.Transporter 2 Company Name 9.Transporter's Phone <br /> f <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. 'ES-tinder HSC 25143 2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DTT meeting requirements for <br /> 1, _ �ection 25413 9 <br /> 13. <br /> C. <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,NV 89701 209-944.9555 <br /> 116,Additional Description for Material Listed Above <br /> fixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> ion-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> II nder the provisions of subdivision(d_)of Section 25:43.2. _ <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 my waste and am taking advantage of new technology and existing DISC <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 Signature - Month Day Year <br /> eXt mS r� <br /> 19.Transporter 1 Acknowledgement of Receipt of a r <br /> Print/Type Name �Si re Month (Day <br /> Year <br /> MOM <br /> 20.Transporter 2 Ackn wledgement 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 _____[Month Day Year <br />