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Excluded Recyclable Material 1.Bill of Lading>i 2. Document Number <br /> Manifest 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 4 <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 11. Containers 12.Total Quantity 13.Unit,Wl. Recycled Pursuant <br /> A. No. 'Y� Volume to HSC 25143.2 <br /> Metal Shredder Aggregate-Excluded Recyclable Material 001 D•I• 1 F.5-Under I IS('2514-12 <br /> I' meeting requirements liir <br /> l; — -- ---_-- Scown 25,111.) <br /> C. <br /> D. <br /> 14. Recycling Facility Name and Mailing Address <br /> 15.Facility Phone <br /> Universal Service Recycling Nevada I.I.C.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 /> on-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.Geneiators Cerlification:I hereby drelare 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 recognize that 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 SB 14 by selectinp,the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Representative/Print Name Signature <br /> Month Day Year <br /> FTorter 1 Acknowledgement of Receipt of Materials' <br /> Name Signature Month Day Year <br /> . ransporter 2 Acknowledgement of Receipt of Materials _ <br /> Print/Type Name Print/Type Name - - <br /> 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 /> Print/Type Name Signature <br /> Month Day Year <br /> J <br />