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FTPS Technologies Soil Recycling <br /> V <br /> Manifest Non-Hazardous Soils 4V mastt � »4 <br /> pr <br /> FIDIaleo4ent Responsible for Payment Transporter Track#- Facility# Given by TPS toadGenerator 0 00014mc,and Billing Address Gcncrator s Phonc# Generator s US EPA 1D No <br /> AMAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET Person to Contact <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consult-int s Naine and Billing Addreas Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Persson to Contact <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US (916) 939-2172 4HORIZO <br /> Gc aeration Sitc(Transport from) {na)ne.&address) Site Phone# BTEX <br /> Levels <br /> BEACON STATION #1-64I Person to ontact TPH I <br /> 1210 EAST HAMMER LANE levels <br /> A0 FAX# AVG <br /> yLevels , <br /> 51OCKTON.- 95210 US <br /> VDesignated Facility(Transport to) (name&addn ss) Facility Phone# Facility Permit Numbers <br /> ti _ <br /> .0 TIPS TECHNOLOGIES INC. 8778 <br /> Person to Contact <br /> ti <br /> 20 RECYCLING LANE Cheran Rice/Don Mur>aehima <br /> $ FAx# <br /> RTCHMUND, CA 94801 USA (510) 231-4154F <br /> } <br /> Transporter Namc and Mailing Address Transporter s Phonc.# Transporter s US EPA ID No <br /> LUTREL TRUCKING (805) 399-0246 <br /> Person to Contact Trinsporter s DCCT No <br /> 6315 SNeW--ROAD <br /> HERMAN <br /> s FAX# Customer Account Number with TPS <br /> SAtFRSFIELD, 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❑ 0-10% ❑ Gas ❑ f <br /> Oilier ❑ <br /> 10-20% ❑ Diesel ❑ y <br /> t0 (� 7 4 J <br /> Cls <br /> y ❑ 20%-over❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ other ❑ <br /> 10-20% ❑ Diesel ❑ Zy <br /> 20%-over❑ Other ❑ <br /> List any exception to items listed above v <br /> Generator's and/or consultant's certification IlWe certify that the soil referenced herein is taken entirely from those soils described to 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 /> any way <br /> Pant or Type Name Generator ❑ Consultant ❑ Signa and date Month Day Year <br /> b�j- 17 9 <br /> t Transporter s certification IIWe acknowledge receipt of the soil described above and certffy that such soil is being delivered in exactly the same <br /> Ccondition as when received IlWe further certify that this soil is bong,d ectly transported from the Generation Site to the Designated Facility x <br /> H without off-loading,adding to,subtracting from or in any way delaytn de& ery to such site <br /> PnSr Type Name gnaw and date , Mo h Pay la, <br /> E <br /> 6111- <br /> 101V PL4 <br /> yr <br /> D�panaes f ,� <br /> �n 3 <br /> S 4 <br /> Q <br /> lous 't <br /> tz <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> V Print or Type Name Sa attire and date <br /> rx <br /> Pisses print or tyPe ° <br /> r < <br /> TPS INVOICING COPY <br />