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' } hPS Technologies Soil Recycli <br /> ,Non-Hazardous Soils 't ' <br /> Date of Shipment / Responsihle fe r P hmenY. Transporter Truck ik Facility;: " Given by TPS: Load; <br /> ' - _ �c�Y �❑ns,_t -mom A07 ��84is ;. ... `I <br /> R�enerator's N2me and Billing Address: Generator's Phone: Generator's US EPA ID No, <br /> RYDER TRUCK RENTAL, INC. <br /> y 360ib NW 82ND. AVE. <br /> Person to Contact:4 <br /> j MARYLYNN DUUGLAS <br /> i <br /> FL .:�J 1[',6 - <br /> FAX;: Customer Account Number with TPS: <br /> ' USA 7..1 DER'(' <br /> Cons Ifznt's Name and Billfn Address: Consultant's Phone;: <br /> F12 Y ENVIROIMENTF (549) 723-1645 <br /> 2817 AI-AFAYETTE AVE„ <br /> Person to Contact: <br /> EVAN PRIVETT <br /> FAX;: Customer Account Number wIG.l'P� <br /> NEWPORT BEACH, CA 9i Gr USA (944).. <br /> 7123-1854 10210650 <br /> Generation Site ransport from): (namr fi Mdress) <br /> ((rr Site Phone;: BTEX <br /> RYDF_R LC1071 FP.EYI <br /> Levels <br /> Person to Contact: Tptl <br /> ' c 36 DUOK CRF'EE! DRIVE _ Levels <br /> m <br /> FAX AVG. <br /> c <br /> STOCKTOh:, t H ^.Ln(hC1 c USG Levels <br /> UDesignated Facility(Transport lo): 6wnir 6 address) Facility Phone;: Facility Permit Numbers <br /> 8162--c?OOI <br /> U Person to Contact- <br /> 12328 <br /> ontact12328 HIBISCUS L7ELLEhiA JEFFREY <br /> D - <br /> A FAX;: <br /> c ADEI_ANTu. CA 42'301 USA (7E10 1 46 -Bk3k 4 <br /> Transporter Name and Mailing Address: Transporter's Phone;: Transporter's US EPA ID No.: <br /> B. E. S. I, (44 1 46Qt--520C CAD563584= .B_; <br /> 2'5422' -- <br /> 2542 T PABLICO R_), #I05--S'6 9 FFAX#:_ <br /> on to Contact: Transporter's DOT No.: <br /> ARRY MDOTHAF.,T 450647 <br /> Customer Account NumberTPS <br /> EL I-ORD, CF', 92631` USA 4.9) 460-9,2 10 10001 <br /> Description of Soil Moisture Content Contaminated by: Approx.Dty: Description of Delivery Gross Weight Tare Weight NetWelght 1 <br /> ' Sand ❑ Organic❑ 0-10% ❑ Gas .I <br /> 10-20% E2 Diesel ❑ /�� �� ` J` I mY1'� 1/rI� <br /> u ClE2 <br /> %-over El Other <br /> Clay A Other <br /> I Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> 10-20%-o ❑ Diesel ❑ /}� -1 <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ !J' <br /> i �f: <br /> list any ezception ro items listed above: <br /> ZZa Generator'sand/or tonsgltdnt's ceXtificnizon:.I/We certify thiat,�the soil referenced herein•is taken entirely front those soils described in the Soil Data <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 c;. 1 <br /> any way. ; <br /> tint or Type Name: Generat. Consultant ❑ Si lure an ate: ` <br /> Monty Day Year '•�; <br /> Transporter's certification: I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> o condition as when received. We further certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> a without off-loading,adding to,subtracting from or in any way delaying delivery to such site. <br /> ' PrintorT NameBn: Si .tare and datr. <br /> Month D Year <br /> Discrepancies: , <br /> 01 <br /> t Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: - <br /> V i <br /> v �°rY&IF-NEYlU. °RC VANSA:.. Signatum and date: <br /> - TPA INVnlrintr_ rnov <br />