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M_ anifest r <br /> .Document Number <br /> USR 2018-000-i���) 3•Date i- <br /> t 4.Generator's Name and Mailing Address ;;.V r -a- <br /> S.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. <br /> Recycled Pursuant <br /> A. No. Type Volume to HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001v04-Under FISC'_'514j? <br /> DT 1 �. f liecting rcquirenwnts liar <br /> B. ` ection 23413.9 <br /> C. <br /> D. <br /> 14.Recycling Facility Name and Mailing Address <br /> Universal Service Recycling Nevada LLC.S8S5 Sheep or.Carson City,NV 89701 15.Facility Phone <br /> 16.Additional Description for Material Listed Above 209-944-9555 <br /> Ixture 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:l hereby declare that the contents of this consignment are fully and accurately described above b <br /> Sacked,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 a V proper shipping name and are classified, <br /> iazardous waste regulations.As the generator,1 am making a good faith effort to minimize my waste and am taking advantage of new technologya <br /> appearance,these commodities are being recycled and are either non-hazardous or conditionally exempt from <br /> egulations to comply with SB 14 b selectingthe best methods that are available to me and that are economical! <br /> y nd existing DTSC <br /> y practical, <br /> ienerator or Authorized Representative/Print Name Signature. <br /> 1 <br /> Month Day Year <br /> 9.Transporter Acknowledgement of Receipt of Materials1 <br /> 1 j j <br /> int/T pe Name <br /> � Signature <br /> i b"� Month Day <br /> 1.Transporter 2 Acknowledgement of Receipt of Materials 013 <br /> nt/Type Name I� ----- <br /> Print/Type Name <br /> Month Day Year <br /> Discrepancy Indication Section <br /> Facility Operator:Certifcation of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted <br /> t/Type Name on line Zl <br /> Signature <br /> " Month Day Year <br /> ___-._--- <br />