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TPS Technologies Soil Recycling <br /> } Manifest Non-Hazardous Soils 5Y ' ' Man $ <br /> _ <br /> Dat of Ship ent Responsible for Payment Transporter ck#- 7 1 Facility# Given by TPS Load A <br /> ��(`7 Generator "�� � o OE 00014 2 's� <br /> Guierator s Name and Billing Addsti Ccnc rator,Phone# Generator s US EPA No <br /> ULTRAMAR, INC. Y <br /> 525 WEST THIRD STREET Person to Contact <br /> TERRANCE FOX <br /> FAX# Customer Account Number%vith TPS <br /> HANFORD, CA 93230 USA (209) 583-3282 19OZ367 <br /> F <br /> Consultant s Name and Billing Address Consultant s Phone# <br /> i <br /> HORIZON ENVIRONMENTAL ( ) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY PerSontoContaet <br /> GARY BARKER � <br /> SUITE 7 FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US .939.-2172 4HORIZQ <br /> Gc tiiratron Site(Transport from) (na)ne&addrebs) Site Phone It BTEX <br /> Levels <br /> BEACON STATION #1--641 <br /> Person . l 583 3247 on act TPH <br /> 1210 EAST HAMMER LANE Levels <br /> FAX# AVG <br /> SjQQKT0 . CA 95210 USA Levels <br /> C <br /> VDesignated Facility(Transport tot (name&address) Facility Phone# Facility Permit Numbers <br /> I 1A) 23-9-6778 <br /> ° TPS TECHNOLOGIES INC. <br /> Person to Contact ; <br /> 20 RECYCLING LANE Cheron Rice/Don Murashima <br /> Q FAX# <br /> CA "SA _ <br /> 4154 <br /> Transporter Name and Mailing Address Transporter s Phone# Transporter's US EPA ID No <br /> x LUTREL TRUCKING (905) 399-0249 <br /> Person to Contact Transporter s DOT No <br /> 6315 SNOB ROAD " <br /> HERMAN <br /> FAX# Customer Account Number with TPS <br /> BAKERSFIELD, CA 93308 4LUTREL <br /> Description of Sod Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ Organic Q 0-10% ❑ Gas ❑10-20% ❑ Diesel ❑ <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ 90 1)1pq 22 <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> 10-20% ❑ Diesel D 45' r <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ <br /> Inst any exception to items Listed above <br /> Generator's andlor 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 by mews for the Generation Site shown above and nothing has been added or done to such soil that would alter it in r <br /> anyway kAiT rot 77A NVPI `} <br /> Print or Type[Name Generator ❑ Consultant ❑ Signatare and date Month Day Year *' <br /> � _ .Q 179c <br /> ai Transporter's certification IlWe acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same c <br /> ocondition as when received IIWe further certify that this soil is being directly transported from the Generation 45ite to the Designated Facility c <br /> y without off-loading,adding to,subtracting from orin any way delaying delivery to such site sf <br /> print or Type Name <br /> Signature and date r Month Daly Year <br /> F' <br /> a <br /> Discrepancies L <br /> V •ti <br /> C I{ecychng Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> ]Vytltkt 4r Type Name Signa and date <br /> rfrlt or type. T <br /> w <br /> TPS INVOICING COPY <br />