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S I " Excluded Recyclable Material 1.Bill of Lading# 2.Document Number 3.Date Manifest USR 2018-000- )cl ! r 4.Generator's Name and Mailing Address 5.Generator's Phone ' Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 6.Transporter 1 Company Name 7.Transporter's Phone Universal Service Recycling,Inc.3200 S.EI Dorado St.Stockton,CA 95206 209-944-9555 8.Transporter 2 Company Name 9.Transporter's Phone 10. US OOT Proper Shipping Name 11, Containers 12.Total Quantity 13.Unit,wt. Recycled Pur cant No. Type Volume to HSC 25143[2 A. VIUS Under I S('25143.2 Metal Shredder Aggregate-Excluded Recyclable Material 001 DT 'CI 1„� t' cuing TLquii emenis lin W mlion 25413 9 B. C. I D. 14.Recycling Facility Name and Mailing Address 15.Facility Phone Universal Service Recycling Nevada LLC.5855 Sheep Dr.Carson City,NV 89701 209-944-9555 16.Additional Description for Material Listed Above Mixture of materials containing plastics and recoverable metal;coarse and fine-grained materials including recyclable metals,recyclable plasti i,and on-recyclable materials Including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material under the provisions of subdivision(d)of Section 25143.2. 17.Special Handling Instructions No special handling required;inquiries contact: Universal Service Recycling Project-Excluded Recyclable Material 24 Hr.209-751-9946 for Environmental Health and Safety Manager 18.Generators Certification:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are class"ied, packed,marked,labeled and are in all respects in proper condition for transport according to applicable domestic regulations. 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 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 D SC regulations to comply with SB 14 by selecting the best methods that are available tome and that are economically practical. Generator or Authorized Representative/Print Name Signature Month Day Year 19.Transported 1 Acknowledgement of Receipt of Materials Print/Type Name Signature} Month Day Year 20.Transport2 Acknowledgement of Receipt of Materials Print/Type Name Print/Type Name Month Day Year I 21.Discrepancy Indication Section 22.Facility operator:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 2 Print/Type Name Signature Month Day Year J t,Y, ' y 11 u 1OA I