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""`S ec�h�s�Yiol -'res oti€R ""cl- <br /> `.c oniI ous or( <br /> ate m Re`s' eri � ylh':2�;l;Cy�'�`�" <br /> eski,, 4 006fb2, '3 <br /> i a Getera6pr's�Igrne and '3114 <br /> '1x dM1*' 't•aieracor's Phone C. +£ Generator's IA EPA ID Na c' <br /> y �rob�� Produot.�ei;� {925) '299=8891 - <br /> P: : .`Sox .5077 <br /> Person a Con e <br /> FAXa; Customer Account Number with TPS .T <br /> Buena Park,";:CA 90622 USA <br /> Consultant's Name and Billing'Addnss: „ ' - -' Cdnsultant's Pion C. ' <br /> Secor - <br /> 1223 Pear Avenue Pte°"t°❑° 'a" ^'ti <br /> Robert Potter <br /> FAX#: Customer Account Numberwith TPS: <br /> 2fountaid' View, CA 00000 USA _ <br /> Generation Site(Transport from): (name baddres\s) Site Phone a: - BTEX - <br /> ARCO !04493 4--.6850 <br /> Levels <br /> . Person to onta, T1'H <br /> 205 North Center Street Levels <br /> . FAXa: AVC. <br /> Levels <br /> USA <br /> ['. <br /> V- Designated Facility(Transport to): (name 6 address) Facility Phone C. - Facility Permit Numbers <br /> `o TPS TECHNOLOGIES INC. 510-235-8778 <br /> Person to Contact: . <br /> m 20 Recycling Lane Debra Tuch®en <br /> FAxa: <br /> Richmond CA 94801 USA 510-211-4154 <br /> Transporter Name and Mailing Address: Transporter's Phone a: Transporter's US EPA ID No.: <br /> Dillard Environmental a' <br /> P. O. Box 578 - Person to Contact: Transporter's DOT No.: <br /> FAXa: Customer Account Number with TPS: <br /> Byron; CA. 94514 USA (925) 634-0569 1002780 <br /> Description of Soil Moisture Content Contaminated by: Approx Gty: Description of Delivery Gross Weight TareWeight NM Weight <br /> sand a 0,8 n a 0-10% ❑ Gas o 7� <br /> -':Clay a other a 10-30% ❑ Diesel ❑ D <br /> 20%-over a Other O <br /> S.0 cl owrui a - 0-1.0%- o cas ❑ - <br /> .Oay a Othm ❑ 10-20% ❑ Diesel Cl t <br /> Z0%-Meru. onrer ❑ <br /> ILA my exeptlm to Item lisaxi above <br /> Generator's and/or consultant's certification: I/We certify that the soil referenced herein is taken entirely from those <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way. <br /> Hint or Type Name: Ceranatm a C rsslunt O Sigruture and datr. Month I Day I Year <br /> y Transporters certiifimtion: I/We acknowledge receipt of the soil d above and certify that such soil is being delivered in exactly the same <br /> acondition as when received. 1/We further certify that this soil is beln directly transported from the Generation Site to the Designated Facility <br /> q without off-loading,adding to,subtracting from or in any way de every to such site. <br /> C Print or date mW W <br /> r = r: <br /> t <br /> a <br /> S Recycling Facility certifies the receipt of the snit covered by this manifest except as noted above. <br /> UPrint or Type Namr. and date <br /> T9ANcon0TF9C rr%DV <br />