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TPS Techhologies Soil Recycling <br /> Non-Hazardous Soils <br /> Date of Shipment Responsible for Payment Transporter Truck# Facility# Gn en by TPS Load# <br /> CIA-L(000len ultrant A04 00729 0 l <br /> Generator s Name and Billing Address Generator b Phone# Generator s US LPA 1D No <br /> Dfesel performance (200 ) 946-0233 <br /> 2334 Eaet Fremont Street Person to Cont ict <br /> Lori n <br /> hielde- <br /> FAX# Customer Ac Count Number with 1 PS <br /> Stockton, CA 95205 USA ( 2091 946-0831 4DIESEL <br /> Consultant s Name and Billing Address Consultant ti Phone# <br /> ATC — Madeat:o <br /> 1177 Lone palm Avenue Person to Cont ict <br /> Jeanne Home+ey <br /> Suite $ FAX# Customer Account Number A ith TPS <br /> Hade$ta, CA 95351 USA" #?®g# 7�-�2�� 1004170 <br /> Generation Site(Transport trom) bianie&address) Site Phone# BTFX <br /> Levels <br /> Person o Contact " TPH <br /> C _naM r4aat F o-gIgp it; F4troalB' C.rLevels <br /> w FAX# c AVG <br /> Z Stockton. CA 95205 LISA e ->rh a ti Levels <br /> c <br /> VDesignated Factlitv(Transport to) Otnme&address) Fa�ihty Phone# Facilith PErrrut Numbers <br /> `o TPS TECHNOLOGIES INC. 510--:.35-8776 <br /> Person to Contict <br /> 20 Recycling Lane Debre Tuchsen <br /> O FAX# <br /> RlChmonrl, Cil 94801 TUFA 510-23i-4154 <br /> q) Transporter Name and Mailing Address Transporter s Phone# Transporter s US EPA[D No <br /> Person to Contact Transporter s DOT No <br /> FAX# Customer Account Number with TPS <br /> Description of Sod Moisture Cont9t Contaminated by Approx Qty Description of Delivery Gross weight Tare Weight Net Weight <br /> 07107 ❑ Gas �n <br /> Sand 'r Organic❑ 10-20% ❑ Diesel ❑ <br /> Clav ❑ Other O 200/-over❑ Other ❑ <br /> Sand ❑ Organic❑ 0 10% ❑ Gas ❑ <br /> 10 20% ❑ Diesel ❑ <br /> Clay ❑ Other O 20%-over❑ Other ❑ <br /> list any excephon to items listed above <br /> -Generat(x;s and/or consultant's certification I/We cert that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> 3&t coip'lefed 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 <br /> any way '� <br /> Print or type Name Generator ❑ Consultant U +N gra re and-Mtr' Month Day Year <br /> i <br /> 6s Transporters certification I/We acknowledge receipt of the soil described above and certify that such soil is being delili f4d iTexactl the same <br /> ccondition as when received I/We further certify that this soil is being directly transported from the Generation Site to the Designat d(?acility <br /> H without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> Print or Type a Signature and date'` � Month Day Year <br /> Dtscre ancies <br /> U <br /> 74 <br /> k <br /> CRecycling Facility certifies the receipt of the soil covered by this mantfest except as noted above <br /> Print or Type Name 5ignature and date <br /> V <br /> Mal <br /> Gl <br /> Pe ntor <br /> GENERATOR CONSULTANTS COPY <br />