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Exclu led Recyclable Material 1.Bill of Lading f# r�- 2.Document Number 3ro Date <br /> Mani est r)5_6 J USR 2018-000. 3 1/ 1 <br /> 4.Gei erator's Name and Mailing Address S.Generator's Phone <br /> Unive sal Service Recycling,Inc,3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 <br /> 6.Trai isporter 1 Company Name - 7.Transporter's Phone <br /> Unive sal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 8.Trai isporter 2 Company Name 9.Transporter's Phone <br /> 10.U DCCT Proper Shipping Name 11. Containers 12.Total Quantity 13.Unit,wt. Recycled Pursuant <br /> No. Tyoe Volume to HSC 25143.2 <br /> A. VES-Under HSC 25143.2 <br /> Meta Shredder Aggregate-Excluded Recyclable Material 001 DT a/,,2 3 T meeting requirements for i <br /> `ection 25413.9 <br /> C <br /> t <br /> D <br /> I <br /> 14.R ycling Facility Name and Mailing Address 15.Facility Phone <br /> Univei sal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City,NV 89701 209-944-9555 <br /> 16.Ad iltional Description for Material Listed Above <br /> Mixturi of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plastics,and <br /> Snon-re( dable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> under t ie provisions of subdivision(d)of Section 25143.2. <br /> ­ff Sp cial Handling Instructions <br /> No spi cial 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.G $rators Certification:l hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,-narked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations. I <br /> lalso ecognize that in spite of product name or appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> hazardo is 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 DTSC <br /> regulatn ns to comply with 5814 by selecting the best methods that are availaNe to me and that are economically practical. <br /> General or or Authorized Representative/Print Name Signature Month Day Year <br /> j 19.Tra isporter 1 Acknow;edgement of Receipt of Materials <br /> Print J MeName Signature Month Day Year <br /> E 20.Tra sporter 2 Ac nowledgement of Receipt of Materials <br /> Print/I epe Name Print/Type Name Month Day Year <br /> 21.Dis repancy Indication Section <br /> 22.Fac ity Operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/T pe Name Signature Month Day Year <br /> i <br /> 5 . <br />