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Excluded Recyclable Material 1.Bili of Lading# 2.Document Number 3.D to <br /> 'ManifestUSR 2018-000- 2,�j 'dn <br /> 4.Generatgr's Name and Mailing Address 5.Gen(rator's Phone <br /> Universal Service Recycling,Inc.3200 S.El Dorado St.Stockton,CA 95206 209-944-9555 <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 `Cl 0 T meeting requirements for <br /> Section 25413.9 <br /> B. a <br /> c tor- <br /> t iarkP <br /> I a.• <br /> C.17 <br /> D. <br /> 14. Recycling Facility Name and Mailing Address 15.Facility Phone <br /> Universal Service Recycling Nevada LLC.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 /> on-recyclable materials including foam rubber,insulation materials and entrained soil and grit.Shipped aggregate is an excluded recyclable material <br /> under 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.Generao.rs 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,merrTed,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 selecting the best methods that are available to me and that are economically practical. <br /> Generator or Authorized Representative/Print Name Sign gtut[ Month Day Year <br /> 19.Transporter 1 Acknowledgement of Receipt of Mfjer <br /> Print/Type Name — SigA#ure Month Day Year <br /> 20.Transporter 2 Ack owiedgement of Receipt Qf Materi'als <br /> Print/Type Name Print/Type Name Month Day Year <br /> 21.Discrepancy Indication Section <br /> air derdp— <br /> ,�nu <br /> d AV <br /> 22.Facility Operatof:Certification of Receipt of Excluded Recyclable Materials by this Document except as otherwise noted on line 21 <br /> Print/Type Name Signatur ij <br /> Month Oay Year <br /> Z , 2 - N <br />