Laserfiche WebLink
,1 TPS Technologies Soil Recycling <br /> 0525 <br /> feS Non-Hazaxdous So><ls11Ain#6-st # y Shipment Responsible for Payment TransporterT ck It Facility# Given b TPS Load# <br /> 17—,q6 Generator �� 2� C 0 0014or s Name and Billing Addren% Generator s Phone# Generator s US EPA ID No <br /> LTRAMAR, INC. (209) 583-5545 <br /> WEST THIRD STREET Person to Contact ' <br /> TERRANCE FOX h� <br /> HANE'ORD, CA 93230 USA <br /> FAX# CustomcrAccount Numlxrwith TPS <br /> (209) 583-3282 1002367 l <br /> Consultants Namc.and BilluiAddress Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Pers<„WJVCtBARKER <br /> SUITE 7 <br /> FAX# Customer Account Number with TPS � <br /> EL DORADO HILLS, CA 95762 U5 (916) 939-2172 4HORIZO <br /> Generation Site(Transport From) (xa,trc&address) Site Phone# STEX <br /> BEACON STATION #1-641 (209) 583-3247 levels <br /> 1210 EAST HAMMER LANE Person to Contact TPH <br /> fi 'JERRY UNRUWk 1 eve3s <br /> �n <br /> s +` FAX# AVG <br /> STOCKTON, CA 95210 US (209) 583-3282 Levels <br /> VDesignated Facility(Transport to) (name&addn Gs) Facility Phone# Facility Permit Numbers <br /> `o TPS TECHNOLOGIES INC. ( 510) 235-8778 <br /> 20 RECYCLING LANE Peron to Contact <br /> to Cheron Rice/Don Murashime <br /> _u o <br /> ;< w, RICHMOND, CA 94801 USA <br /> FAx# (510) 231-4154 x <br /> d Transporter Name and Mailing Address Transporter's Phone# Transporter s US EPA ID No <br /> LUTREL TRUCKING (805) 399-0246 <br /> 6315 SNOW ROAD Person to Contact Transporters DOT No <br /> HERMAN <br /> BAKERSFZELD, CA 93308 FAX# Custorne4Qcggy jkr with TPS <br /> Description of Soil Moisture Content Contaminated by Approx 4ty Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ Organic❑ 0-10% Q1Gas ❑ <br /> Clay ❑ Other ❑ 10- ❑ Diesel ❑ <br /> -o <br /> 20%-over ❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ 10-20%u ❑ Diesel ❑ <br /> er 20%-over❑ Other ❑ <br /> €ist any exception to items listed above <br /> ei <br /> Generator's and/or consultant's certification 1/We certify that the soil referenced herein is taken entirely from those sails desmbed to the Soil Data <br /> Sheet ebmpleted and certified by melus for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any uriy & UMp <br /> MAk <br /> Print or Type Name Genemlor ❑-` Consultant ❑ Signature and to Mon pay Year <br /> �C Y !7 196, <br /> L 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 /> condition as when received IIWe further certify that this soil is being directly transported from the Generation'Site to the Designated Facility <br /> Hwithout off-loading,adding to,subtracting from or in any way delaying delivery to such site- <br /> Print or Type Name_ Sand date Mon Qay Year <br /> Ica <br /> ignature <br /> Discrepancies +'1 <br /> LL <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above x« <br /> Print or Type Name Signature and date ';�P <br /> 'Cheron L. Rice/Don S. Murashima <br /> S� e <br /> a <br /> Please print or type <br /> TPS INVOICING COPY <br />