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,table Material 1.Bill of lading tf 2.Document Number .t/ .Date <br /> tifest USR 2018-000- t Z <br /> 3enerator's Name and Mailing Address 5.Generator's Phone <br /> dniversal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <br /> 6.Transporter 1 Company Name 7.Transporter's Phone <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-9449555 <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. ES-Under HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 DT 'p meeting requirements for <br /> Section 25413.9 <br /> B. <br /> C. <br /> D. <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 /> 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 /> nder the provisions of subdivision(d)of Section 25143.2. <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 recognizethat 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 DTSC <br /> regulations to comply with SS 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 /> AW-YOS i 12- <br /> 19.Transporter 1 Acknowledgement of Receipt of t is <br /> Print/Type Name Sign t Month Day Year <br /> S '�1_ � 0 <br /> 20.Transporter 2 Ac now edg ment 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 /> PPriintt-/TTy-peName Signature Month Day Year <br /> Z `6 cd <br />