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„ �, TPS Technologies Soil Recycling <br /> .Mari1feSt `'� r Non-Hazazdous Soils '4, 11 anifest#,�+, <br /> Date of Shipment- Responsible for Payment Transporter Truck# Facility# Given by TPS Load 0 <br /> Generator 4 3"78 ` 0 00014 1 <br /> , <br /> GCnUator s Namc-ind Billing Address Generator s Phone# Generator s US EPA ID No <br /> ULTRAMAR, INC. - } <br /> 525 WES'R THIRD STREET Pcrsontocontact r <br /> awe <br /> FAX# Custonwr Account Number with TPS <br /> HANFORD, CA 93230 US <br /> Consult int s Namc and Billing Address Consultant i Phone# <br /> HORIZON ENVIRONMENTAL939-7170.. <br /> 5011 GOLDEN FOOTHILL PARKWAY PLrs0n to tonlalt <br /> GARY BARKER <br /> SUITE 7 FAX# CnStOMLr Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US <br /> 939-2172 414nRT7Q 1 <br /> Generation Site(Transport from) (na,ne&address) Site Phone it BTEX p= <br /> Levels <br /> BEACON STATION #1-641 Person o on ct TPH , <br /> 1210 EAST HAMMER LANE Lever / <br /> S FAX# AVG <br /> Levels <br /> VDesignated Facility(Transport to) (uanre&address) Facility Phone# Facility Permit Numbers <br /> TPS TECHNOLOGIES INC. (510) 235-A77A <br /> Person to Contact <br /> 20 RECYCLING LANE Cheron Rice/Dor Muraohima <br /> FAX# t <br /> RICHMOND, C 0 r <br /> i <br /> Transporter Name and Mailing Address Transporter s Phone# Transporter s US EPA ID No <br /> LUTREL TRUCKING ( 0 ) 399-0246-- <br /> 315 SNOB! ROAD Person to Contact Transporter s DOT No <br /> HERMAN <br /> FAX# CUStOMLI Account Number with TPS <br /> BA!ERSFIELD, CA 93308 t 4LUTREL <br /> Description of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ <br /> 10-20%-o ❑ DieseOther ❑ Qj�/ �/l <br /> 20%-over❑ Other Cl C1WC�Z5(,J <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> 10-20% ❑ Diesel ❑ ' <br /> CVy—� Other ❑ 20%-over❑ Other ❑ <br /> Lust any exception to items listed above <br /> Generator's and/or consultant's certification IlWe certify that the soil referenced herein is taken entirely from those soils described in the Sot!Data <br /> Sheet completed and cera ed 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 wayA60% �C 46%*'-'1k <br /> Print or Typo Name Generator ❑ Consultant ❑ Si re and date Month Day Year <br /> 0 k2 gn <:54 It 7 1% <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 /> condition as when received IIWe further certify that this sod is being directly transported from the Generation`Site to the Designated Facility <br /> 21 without off-loading,adding to,subtracting from or in anyway delaying delivery to such site <br /> H <br /> Print or Type Name , Signature and dateLa <br /> Man[h /T7ay Year ti <br /> ~ / <br /> Discrepancies <br /> Z, <br /> Recychng Facdity'cerhfles the receipt of the soil covered by this manifest except as noted above, y <br /> Print or Type Name Signature and date s <br /> ,42Z <br /> Hc�� <br /> 4 <br /> Y sS 1 <br /> ` p type <br /> ;s P ritrtor <br /> TPS INVOICING COPY <br />