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TPS Technologies Soil Recycling <br /> ' Minlfest Non-Hazardous Soils <br /> Date of Shipment Responsible for Payment Transporter ruck# Facility# Given by TPS Load# <br /> Generator }�j 0 00014 2 <br /> t, <br /> GCnLr itOr s N ML and Billink Address Generator's Phone# Generator s US EPA ID No <br /> ULTRAMAR, INC. (209) 583-5545r <br /> 525 WEST THIRD STREET Pct�ontoContact <br /> TERRANCE FOX <br /> FAQ{# Customcr Account Number with TPS `ry <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consult-int s/Name and Billing Address Consultant s Phone# <br /> HORI20N ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY PcrsontoContact <br /> SUITE 7 GARY BARKER <br /> FAX# Customcr Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US (916) 939_2172 4HORIZO r; <br /> Generation Sitc(Transport from) (narne fr addrebs) Site.Phone# BTEX .7 <br /> Levels , <br /> BEACON STATION *1-641 Slla-224 <br /> Person o on ct TPH <br /> a <br /> 1210 EAST HAMMER LANE Levels- <br /> � a FAx# JERRY IINRIIH AVGRTOCKTON. CA 95210 USA ` <br /> Levels <br /> C <br /> VDesignated Facility(Transport to) (name&address) Facility Phone# Facrhty Pernut Numbers <br /> 510) <br /> TPS TECHNOLOGIES INC. <br /> Person to Contact — <br /> M� ca 20 RECYCLING LANE Cheron Rice/Dar Murashima <br /> 0 FAX# <br /> tL — <br /> 4154 <br /> ! Transporter Name and Marling Address Transporter s Phone# Transporter s LAS EPA M No <br /> LUTREL TRUCKI dG - <br /> 6315 SNOW ROAD Pelson to Contact Transporter s DOT No <br /> FA X# Customer Account Number with TPS d <br /> BAKERSFIELD, CA 93308 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 ❑ 10-20% ❑ Diesel Cl —7 <br /> 20%-over❑ Other ❑ ` <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ x' <br /> Clay ❑ Other ❑ 10-20% El Diesel a <br /> 20%-over❑ Other ❑ <br /> List any exception to items listed abover <br /> Generator's and/or consultant's certification I/We certify that the soil referenced herein is taken entirely from those sods described in the Soil Data <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 /> F <br /> anywayrot ULD�OAAt <br /> Print or Type Name Generator ❑ Consultant ❑ Sig to and date Month Day I Year <br /> 0 eel 17 <br /> Transporter s certification IIWe acknowledge receipt of the soil described above and cfrtify that such soil is being delivered in exactly the same <br /> JE'Lwrint condition as when received IIWe further certify that this sod is being directly transported from the Generation Site to the Designated Facility <br /> ithout off-loading,adding to,subtracting from or in any way delaying delivery to such site or Type Name Signa and date Month �y Year } <br /> *a <br /> D�screpanctes <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted abovet <br /> Pont or Type Name Signature an date <br /> C° H�RdN <br /> s TPS INVOICING COPY <br />