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• yL1auie tviaterial I1.Dill of Lading 11 _ <br /> Manife2 <br /> st . Document Number 3.Date <br /> USR 2018-000- <br /> 4.Generator's Name and Mailing Address --- <br /> 5.Generator's Phone `-- <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> 6.Transporter 1 Company Name 209-944-9555 <br /> 7.Transporter's Phone -- <br /> Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 <br /> 8.Transporter 2 Company Name 209-944-9555 <br /> 9.Transporter's Phone -- <br /> 10. US DOT Proper Shipping Name <br /> 11. Containers 12.Total Quantity 13.unit,wt. Recycled Pursuant <br /> A. --- N rY�O Volume to HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 lyl YES-Under IISC'251.11.E <br /> I' meetingmluirements lin <br /> -- - -- tiection 25,1131) <br /> C. - - — <br /> D. --- — <br /> 14. Recycling Facility Name and Mailing Address <br /> 15. Facility Phone — <br /> Universal Service Recycling Nevada LLC.5855 Sheep Dr. Carson City,NV 89701 <br /> 16.Additional Description for Material Listed Above 209-944-9555 <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 _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 b <br /> packed,marked,labeled and are in all respects In proper condition for transport according to applicable domestic regulationsopershepping name and are classiRed, <br /> I also recognize that in spite of product name or appearance,these commodities are being recycled and are either nonhazardous 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 /> ,egulations to comply with SD 14 by selecting the best methods that are available to me and that are economically practical. <br /> .3enerator or Authorized Representative/Print Name Signature — <br /> Month Day Year <br /> 1.9.Transporter 1 Acknowledgement of Receipt of Materials <br /> Irinl/type Name — --- —- -- <br /> Signature _ <br /> Month Day Year <br /> 0.Transporter 2 Acknowledgement of Receipt of Materials/ <br /> rint/Type Name =Type -- ---- <br /> Month Day Year - <br /> 1. Discrepancy Indication Section <br /> L Facility Operator:Certification of Receipt of Excluded Recyclable Materials by this Documentexec p sat otherwise noted on line 21 <br /> int/Type Name <br /> Signature% Montle Day Year <br /> "A 42 I G -- <br /> - / -- -- 4- <br />