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i <br /> TPS Technologies Soil Recycling f o <br /> Manifest , Non-Hazardous Soils ;�^{�' Min 4$t•�s'�' � <br /> Date of S rpment: Responsible for Payment Transpo r Truck* Facility# Given by TPS Load 0 4 <br /> Generator 17 L 0 00014 2 <br /> Gc ncrator s N imc and Billing Addrec,s Generator s Phonc# Generator s US EPA ID No <br /> ULTRAMAR, ,INC. (209) 583-5545n <br /> 525 WESY* THIRD STREET PtrsuntuContaet <br /> TERRANCE FOX <br /> FAX# Customer Account Numbcr with TPS <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 `r <br /> Consultant S Name ind Billing Address Consultants Phone# k <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Person to Contact <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TI'S 1 <br /> EL DORADO HILLS, CA 95762 US (916) 939-2172 4HORIZO <br /> z I <br /> Generation Site(Transport from) (name.&address) Site Phonc# BTEX <br /> Levels <br /> BEACON STATION #1-641 <br /> 420Q) 563-324-7-- <br /> Person to Contact TPH <br /> `C 1210 EAST HAMMER LANE LeN elsJERR <br /> l <br /> FAX# AVG t <br /> C STOCKTOH CA 95210 US _ mels <br /> V L. <br /> Designated Facility(Transport to) (name&addr"a) Facility Phone# Facility Permit Numbers <br /> ~ TPS TECHNOLOGIES INC. (510) 235-8778 <br /> a <br /> Person to Contact ; <br /> 20 RECYCLING LANE Cheron Rice/Don Murashima 4, <br /> FAX# <br /> RICHMOND CA 94801 US (510) 231-4154 <br /> t Transporter Name and Mailing Address Transporter s Phone# Transporter's UJ)EPA ID No <br /> LUTREL TRUCKING (805) 399-0246 <br /> 615 SNOW ROAD Person to Contact Transporter s DOT No <br /> FAX# Customer Account Number with TPS <br /> BA' ERSFIELD, CA 93308 4LUTREL <br /> -c <br /> Description of Sod Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> 830 <br /> -o O <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ other El , <br /> 10-20% O t ❑ Q t�'7 <br /> 20%-over❑ Other <br /> ❑ D I I <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay t] Other O <br /> 10-20 40 ❑ Diesel ❑ <br /> 20%-over d Other t] <br /> List any exception to items listed above <br /> Generator's andlor consultant's certification IIWe certify that the soil referenced herein is taken entirely from those sods described in the Soil Data 14 , <br /> Sheet completed 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 way <br /> Print or Type Name Generator ❑ Consultant U Signature and date MMoonnth Day Year <br /> v 11-7 196 <br /> Transporter's certification IIWe acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> ocondition as when received IIWe 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 way delaying delivery to such site <br /> Print or Type Name Signature and date Month Day Year <br /> mod da <br /> sDn G /7 <br /> Discrepancies <br /> t] <br /> dw <br /> ,Recycling Facrhty certifies the receipt of the soil covered by this manifest except as noted above <br /> ' pF <br /> Print or Type Name Signature and date <br /> CyER o� Z- <br /> PI"Ord or type <br /> TPS INVOICING COPY <br />