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Non-Hazardous Soils <br /> Date of Shipment: Responsible for Payment: Transport Truck#: Facility#: Appro�l Nugrber. Load! <br /> J. <br /> Generator's Name and Billing Address: Generators Phone M <br /> +?bra-41(I j2CO C'AU"_0141411313 <br /> i it U 1?0 A EU/4' Person to Contact. <br /> RPNChi0 CA "21128 6 <br /> FAX#: Customer Account Number <br /> I <br /> dConsultant's Name and Billing Addrew Consultant's Phone#: <br /> l <br /> Person to Contact: <br /> I <br /> FAX#: Customer Account Number <br /> Genet{ion Site(Transport from):(name&address) Site Phone#: <br /> 7 ELEVEN 1 Plu 2O.?,•�'' 3�kr7 <br /> Person to Contact: <br /> g t,4;lTE CA, CA +1.r3;,( <br /> FAX#: <br /> G <br /> V Designated Facility(Transport to):(name 6 address) Facility Phone#: <br /> {(1200)fl�-j"l-evo i <br /> C Person to Contact <br /> r 'r.".i•iS�_. �)T. -A 0,1101 FAX#: <br /> C7 <br /> Transporter Name and Maiting Address: Transporters Phone#: <br /> y1.)x'-�'l/'tf r 4.P' 1V�f ti. Person to Contact: <br /> .I 1 1 1 is:� f-�r� <br /> FOOTHILL R Jk Q1-I C" c7^ 131 LARRY MOOTHANT 4T it 317 <br /> Ecl )R FAX#: Customer Account Number <br /> = R — - y: Approx.— tl► -- _ --- y - �... iE of <br /> Doscri lion of So61 Moisture content Contaminated b Q Description of D�liuor Gross llmi lot Taro lloigilt Not Ilei C <br /> i -- L - - 1 1 - I - ITTI -- <br /> Sand J Organic J 0-10% U Gas lJ <br /> C] <br /> 10-20% J Diesel U }((J (-i, <br /> ((J 1 i <br /> y 4 ` <br /> Clay Other J 20%-over O_ Other Cl <br /> Sand O Organic J 0 10`,1. U Gas U <br /> Clay U Other J 10-20% U Diesel 0 <br /> 20%-over U Other U - r, <br /> U-4 any exception to items fisted above: Scale Ticket# `) r <br /> Generator's and/or consultant's certification:I/We certify that the soil referenced herein is taken entirely from those soils descried in the Soil Data <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing ha been added or done to such soil that would atter it <br /> in anyway. <br /> p Print or Type Name: Generator J Consultant J Signature and date: Mo [Tay,,,—Yeu <br /> :•r�rvLR�t•} .'r# c,r F�r=.Fil �1'l r�•-�,'+ij st) r. �-�.`r. '.si!" _,�..®' ���.. - ---- -��r`�L/ <br /> I l Transporter's certification:1/We acknowledge receipt of the soil referenced above and certify' that such soil is being delivered in exactly the same <br /> o condition as when received.I/We further certify that the soil is being directly transported from the Generation Site to the Designated Facility <br /> Q without off-loading,adding to,subtracting from or in any way delaying delivery to such site. <br /> tocr�peNa e: - r Signature and date: Day, heir <br /> Discrepancies: <br /> t3)' -- �— - <br /> '9 1 Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: <br /> VPrint or Type Name: Signature and date: <br /> a C r 4Fltifai i F'r" ?IP,idr'! , . i <br /> V <br /> GEMERATOR/CO ° ULTAKS COPY <br />