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D f f:T�Technologles Soil Rg� rjtn°yamY „ 9� <br /> N �"'� E� VI'�xti est < Non-Hazardous SoAs # <br /> isa <br /> FULTRAMAR, <br /> Shipment Responsible for Payment Transporter Truck# Facility# Given by TPS Load# <br /> y Generator �� 0 00014or s Nam(_and Billing Addrese Generator s Phone# Generator s US EPA ID No <br /> INC. (209) 583-5545 <br /> 525 WEST THIRD STREET Person toConta.t <br /> TERRANCE FDX <br /> FAX# Customer Account Numbcr with TPS <br /> HANFORD,1 CA 93230 US (209) 583-3282 1002367 <br /> 7 <br /> Consultant s Name andiBitling Address Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 r <br /> 5011 GOLDEN FOOTHILL PARKWAY PLrscmtoContact <br /> SUITE 7 GARY BARKER <br /> EL DORADO HILLS, CE 95762 USA,FA X# Customer Account Number with TPS <br /> (916) 939-2172 4HORIZO <br /> Generation Sat-(Transport from) (name &address) Site Phone#' BTEX " <br /> r BEACON STATION *1-641 ----(209)--.583-3247 Levels <br /> PH <br /> 1210 EAST HAMMER LANE Pii�nt°contact <br /> FAX# Levels <br /> c JERRY UNRUH A <br /> AVG <br /> STOCKTON, CA 95210 US 583-3282 Levels <br /> ti V Designated Facility(Transport to) (name&addre{b) Facility Phone# Facility Permit Numbers <br /> a TPS TECHNOLOGIES INC, ( 510) 235-8778 .� <br /> �e 20 RECYCLING LANE Pers°nt°c°ntaCt <br /> L Cheron Rice/Don Mureehime <br /> ` Q FAX# , <br /> RICHMOND, CA 94801 US (510) 231-4154 <br /> yTransporter Name and Mailing Address Transporter s Phone# Transporter s US EPA ID No <br /> LUTR6L TRUCKING (805) 392-0246 <br /> 6315 SNOW ROAD Person to Contact Transporter s DOT No <br /> �- HERMAN ` <br /> HAKER�FIELD, CA 93308 FAx# Custome4Qc�py hV berwithTPS <br /> z <br /> Description of Soli Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weigt$ Tare Weight Net Weight <br /> Sand ❑ organic❑ 0 10% Q Gas ❑ <br /> Clay ❑ Other ❑ 10-20% O Diesel ❑ "7 / �O ` —14D <br /> ,� �t <br /> 46) <br /> 20`90-over❑ Other ❑ f1 40 Y `�[J it+� <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ 10-20% <br /> 0-20% ❑ Diesel Q <br /> 20%-over❑ Other O <br /> List any exception to items listed above _ r <br /> t <br /> Generator's and/ar consultant's cera ftcapon Il We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data M <br /> Sheet completedand certified by me/us fdr the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way T' 04U1A M r, <br /> �r <br /> Print or Type Name Generator �❑ ConsultantSignature and date Month pay Year <br /> y} <br /> �1 ❑ r <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 fj <br /> Ccondition as when received Il We further certify that this soil is being directly transported from the Generation Site to the Designated Facility .. <br /> y without off-loading,adding to,subtracting from or in any watt delaying dehve 7JNo such site tai <br /> � Print or Type NameI✓U � �� Signature rid d to � Month l�a� Ygar -y c <br /> Y' <br /> Discrepancies <br /> r <br /> fT <br /> r� <br /> Recycling Facility certifies the receipt of the soil covered biythis manifest except as noted above <br /> r <br /> Print or Type Name v Signature and date <br /> Cheron L. Rice/Don S. Murashima <br /> Y f �) 1�,r <br /> E i <br /> } <br /> i Floase print Cr type t t <br /> TPS INVOICING COPY <br />