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5 <br /> TPS Technoilogies Soil Recycling <br /> R' Manifest Non-Hazardous Soils � Nii�nilest r art' �� '4 <br /> 1 <br /> �9 Date f Sht ent Responsible far Payment Trans rte Truck# Facility# Given by TPS Load# <br /> 111 Generator 00014 1 <br /> Generators Namc and Billing Addri s% Gc nerator s Phone# Generator s US EPA ID No .l <br /> ULTRAMAR, INC. 983-55-45 <br /> 525 WEST THIRD STREET Pc rson to ContactTERRANCE FOX <br /> r <br /> F <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consultrint s Namc and Billing Address Consultant s Phone# <br /> 'HORIZON ENVIRONMENTAL939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY PLrson to Contact <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US - 4HORIZO , <br /> Generation Sitc(Transport From) (name&address) Site Phonc# BTEX $ <br /> � Levels <br /> .BEACON STATION #1-641 Person a on act 583 324, <br /> TPH a <br /> 1210 EAST HAMMER LANE L.e%els <br /> FAX# AVG <br /> fiSTOCKTON, CA 95210 USA <br /> Levels <br /> VDesignated Facility(Transport to) (name£r addreGs) Facility Phone# Facility Permit Numbers i <br /> � 4 — t, <br /> TPS TECHNOLOGIES INC. 3� <br /> t Person to Contact <br /> 20 RECYCLING LANE Cheron RIce/Don Muraehima ' <br /> $ FAX# <br /> m <br /> r Y y Transporter Name and Mailing Address Transporter s Phone# Transporter s US EPA ID Nom' <br /> LUTREL TRUCKING - <br /> 6315 SNOW ROAD Person to Contact Transporters DOT No 1_� <br /> HERMAN <br /> FAX# C stomer Accot N}}�bei with TPS <br /> BAKERSFIELD, CA 93308 4LUun;WWL <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 /> L.) -o O <br /> 10- ❑ Diesel O <br /> Clay ❑ Other 1 ✓l �� "T 1 <br /> 20%-over❑ Other <br /> ❑ <br /> Sand ElOrgaiuc❑ Q 10% 0 Gas ❑ <br /> Clay ❑ Other ❑ 10-20% O Diesel ❑ 6- <br /> 20%-over ❑ Other ❑ <br /> Last any exception to items listed above <br /> 1 <br /> Generator's and/or consultant's certification IlWe certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and certified melus for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way ' If R61 V�__4 U67 VM <br /> /I <br /> Print or Type Name Generator ❑ Consultant ❑ Si m and date Month Day Year <br /> lt-Dy o(. <br /> Transporters certification I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> ccondition as when received IIWe further certify that this soil is being directly transported from the Generation];Lte to the Designated Facility <br /> y without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> P. or Name Signature and date Month Day Year <br /> Discrepancies <br /> f] <br /> 4 Recycling Facility certifies the receipt of the soil covered by this nuinrfest except as noted above <br /> }i Print or Type NameSign re and date a L� <br /> l� <br /> t{ <br /> l�Yt YI�Ee.{1f31it or typq a ^y L <br /> TPS INVOICING COPY <br />