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SOIL SAFE OF eA - TPST Manifest Non-Ha7arr1n„c Snilc Manifest # 4L Please print or type. 4 0M 4'0213110 1-1 TRANSPORTER COPY Date of Shipment:? Responsible for Payment: Transport Tru k#: Facility #: Approval Number: Load # ) l Generator's Name and Billing Address: Generator's Phone #: SHELL OIL PRODU T S LIS (CARSON) 71a--829-0:352 id,1r, Person to Contact: CJ0'A1A`{PCE PEPPY, INC. 8281 COIVI:IONVAEALTH AVENUE qndrea 1A4no FAX#: Customer Account Number EUaNA PAPP, CA 006211, Consultant's Name and Billing Address: Consultant's Phone #: "gyp LJ Person to Contact: ( FAX#: Customer Account Number Generation Site (Transport from):(name&address) Site Phone#: ENVIR NIMENTAL HEALTH. SHELL OIL 10040213 (436144) IT Person to Contact: 2575 COUNTRY CLUB Pl-wLETA 10040213 _ _� t rJOKTON!, C -A 0621,14 FAX#: j U Designated Facility (Transport to): (name & address) Facility Phone #: L. (300) g6? 300`1 SOIL SAFE Person to Contact: m 12323 HiBISCUSAVENUE `o JOE PRO�r'�f`—'AL ACIEL,01TO, CA 92301 FAX#: M (760) 2� 15-8004 C7 Transporter Name and Mailing Address: Transporter's Phone #: 949-460-5200 C!,,R000163913 eEL.SHIIRE Person to Contact: 25971 TOVANIE CENTRE DIRIVE LARRY [:400THA.RT ^501;47 t OUTHIt_t- RadVi H, CA 92610 FAX#: Customer Account Number SESI : 284390 34'r�-:1 Pio-5110 Description of Soil Moisture Content Contaminated by: Approx. Qty: Description of Delivery Gross Weight Tare Weight Net Weight Sand ❑ Organic ❑ Clay ❑ Other ❑ 0-10% ❑ 10-20% ❑ Gas ❑ Diesel ❑ DfY 20% -over ❑ Other ❑ Sand ❑ Organic ❑ 0-10% ❑ 10-20 % C]Diesel Gas ❑ ❑ Clay ❑ Other ❑ 20% - over ❑ Other ❑ ' List any exception to items listed above: Scale Ticket # -- Generator's and/or consultant's certification: IlWe certifij that the soil referenced herein is taken entirely fi-om those soils descried in the Soil Data 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 any way. Print or Type Name: Generator ❑ Consultant ❑Signature and date: Month Day Year L arry PAocthart cf 13ESI on behalf of Shell OPUS Transporter's certification: I/We acknowledge receipt of the soil referenced above and certifij that such soil is being delivered in exactly the same o condition as when received. I/We fierther• certify that the soil is being directly transported fi-om the Generation Site to the Designated Facility N without off-loading, adding to, subtracting front or in any way delaying delivery to such site. Print or Type Nmuq: Signature and date: Month Day Year Discrepancies: U tT •E U Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: VPrint or Type Name: Signature and date: .i. FR0VAN SAL �) � Please print or type. 4 0M 4'0213110 1-1 TRANSPORTER COPY