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i <br /> I <br /> SOIL SAFE OF•C/o1 TPST <br /> r rd� Non-Hazardous Soils 11— <br /> Date of Shipment. nesponsible for Payment: Transport Truck 9: Facility 6: Approval Niamber: � Load 0 .i. <br /> 13 <br /> . Generator's Name and Billing Addreas: ` Generator's Phone#: <br /> UPVvUeST COAST PR(,7nXIC-I S, LLQ <br /> Person tnCnntact <br /> P-.0. FOY:8Q249 <br /> '= 92088 <br /> FAX#: Customer Account Number <br /> M1y ' <br /> U <br /> Consultant's Name and Billing Address: Consultants Phone#: =' <br /> U7. <br /> Person to Contact: <br /> ''3' PAX#; Customer Account Number <br /> )e _ <br /> Generation Site[Transport from):(name&addrm) Site Phone� w <br /> 9- 021 eO a=i' <br /> Person to Contact: ., <br /> 1212 i CAUFOrMA <br /> TOC K ON, CA 95204 FAX#. <br /> 'c CJ Designated F---MV(Pranaport to):(name&addreas) Facility Phone#: t, <br /> All <br /> a SOIL S.AFEr <br /> C: PersentoCorttael: ' <br /> 12328 Hi 81�CUB ANENUE <br /> 1 MIELA.NTO, SMA 92301 `- <br /> :. FAX#: iB <br /> _a d <br /> -t TrarLsp)rter Nanec and 116ailing Address. 'IYansportefa Phone N- <br /> M-460-5200 <br /> : ear <br /> rr „.{6p0n.,52)r� ��y�•yn ry L 3' n=' <br /> ffi�� 45JL� rJG.SiI.� t..,{NSS IS{!L:f�•��:c7 <br /> 6EL3HiRE 'z <br /> Person to Contact:,R» +r <br /> Y.. 6:52.,7{ TOJ�,�VE� Cr1V'i�F�1~ DRIVE rs{ � <br /> LA1;71R'"r 1u OOTH.ART d50M r <br /> FOOTHU. CA @26-10 <br /> FAX#: Customer Account Number <br /> OEM: 222447 949-4a0 6210 1 <br /> v!f <br /> =a: Description of Sotl Moisture Content Contaminated by: Approx.Qty: Description at Delivery Gross Weight Tare Weight Net Weight <br /> Rei= ` <br /> ❑ 0-I0% G Gas 10i <br /> ❑5andlOrganic <br /> clay U other QOt� q2D%over <br /> Lp <br /> 7 <br /> ? a-la% ❑ Gas ❑sand❑ Organic❑ ]0-znx ❑ Dlasel Q , ' <br /> w clay E3Dthcr ❑ 2W-00"Vcr ❑ other ❑ <br /> T Lot arty exception to items listed above: Scale Tldmt# �rf � L <br /> t i <br /> ' Cenerator's a4dlor consultant's certification:I/We certify that the Solt referenced herein is taken porqyftom those sails descried in the Soil Data <br /> { Sheet completed and certified by mOm for the Generation Site shown above and nothing has n ad ed or dote to such sail that would alter it <br /> �;� in any way. <br /> Print or Typc Name: Generator ❑ Consultant 13Signature end date: % MoA Day Y > <br /> Transporter's certkation:I/We acknowledge receipt of the soil referenced above and certify that such soil is being delivered in exactly the same g <br /> condition as when received,I/We rther cern that the soil is beiti directly tra orted om the Generation Site to the Designated Facility <br /> o fJ 8 JP gn J I I <br /> 5• wit ut off-loading,adding to,subtracting from or in any way delaying delivery to such site. <br /> 25 N <br /> Signature and date y Y i <br /> 7. <br /> .r•' 1. <br /> > ! <br /> Discrepancies: <br /> RA / r� e <br /> Recycling Facility certifies the receipt of the soil covered by this mani (except as noted above: <br /> ` Print or T [Name: - <br /> �ti_ yip Si lurc,anddete: 'I <br /> _ M > <br /> » <br /> "kia`.- - r <br /> 31€ . 3 ani 1 � $ qraii <br /> TRANSPORTER COPY <br />