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SOIL SAFE OF CA — TPST <br /> Manifest Non-Haza'r'ctous-Sbils y Manifest# 41 . <br /> Date of Shipment: Responsible for Payment. Transport TTtk ft. Facility 0: Approval Number: Load# <br /> V` <br /> Generator's Name 6d Billing Address: <br /> Generator's Phone <br /> -A <br /> OF, <br /> Person to Contact: <br /> PDX <br /> FAX#: Customer Account Number <br /> Consultant's Name and Billing Address: Consultant's Phone#! <br /> Person to Contact: <br /> FAX#: Customer Account Number <br /> Generation Site(Transport from):(nmyte&address) Site Phone C <br /> Person to Contact: <br /> FAX#: <br /> to <br /> O <br /> 0 Designated Facility(Transport to):(sianse&address) Facility Phone <br /> 0 <br /> Person:o Contact., <br /> FAX#: <br /> O Transporter Name and Mailing Address: TransporteYs Phone <br /> 0- <br /> U"E! ., <br /> -4"("M TPerson to Contact <br /> , <br /> FAX#: Customer Account Number <br /> Description of Sall Moisture Content contaminated by: Approx.City: Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand 0 Organic C3 00-2 <br /> Q Gas 0 <br /> Cla0 Other U 10-20% 0 Diesel 0 <br /> y <br /> 20%-over 0 Other 0 <br /> Sand 0 Organic 0 <br /> 0-10% 0 Gas 0 <br /> Clay a Other 0 10-210% 0 Diesel <br /> Cl <br /> -I ", 0 . 0 <br /> 1 20%-over her Ll <br /> List any exception to items listed above: Scale Ticket <br /> Generators and/or consultants certfication:JlWe certifij that the soil referenced herein is taken entirely front those soils descried in the Soil Data <br /> Sheet completed and cert fled by inglusfor the Generation Site shoron above and nothing has been adde4-bi*llone to such soil that would alter it <br /> in any z0fly. <br /> Print or Type Name: Generator 0 Consultant 0 Signature and date: I Month Day I Year <br /> Transporters certification:We acknowledge receipt of the soil referenced above and certify tltrrtsrrch soil is being delivered in exactly the same <br /> condition as when received,Wefiirther certify that the soil is being directly transportedfromthe Generation Site to the Designated Facility <br /> R- without off-loading,adding to,subtracting from or in any way delaying delivery to such site, <br /> V <br /> Prilpt or Type Name: atureand date.. Month Day Year <br /> Discrepancies: -.9 <br /> tL <br /> 0) <br /> :9 Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: <br /> Print or Type Name: Signate and date: <br /> Plens.ei print ortype. <br />