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TPS Technologies Soil Recycling <br /> f Manifest t r Manifest# 4 <br /> 4 Ifon-Hazardous Soils ' <br /> Date of Shipment Responsible for Payment Transporter Truck# Facility# Given by TPS Load# <br /> Generator L �a 0 00014 2 <br /> GLnLritor s Nims and Billing),Address <br /> Gt nEratnr s Phont# GEnLratOr s US EPA ID No � <br /> ULTRAMAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET llcnorltoContact <br /> TERRANCE FOX <br /> FA X# CubtnnlLr Account NumbLr with TPS <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consult int s NamL and Billing Addn bs Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOT ILL PARKWAY Person toContak-t <br /> SUITE 7 GARY BARKER <br /> FAX# Customi-r Account Number with TI'S <br /> EL DORADO HILLS, CA 95762 US (916) 939--2172 4HORIZO <br /> GLntratron Sltc (Transport from) (Kine&addre�sa) Sitc Pllollc# BTEX t <br /> Levels <br /> BEACON STATION #1-641583-32 <br /> 47 <br /> ~ <br /> s. Person to Contact TPH <br /> 1210 EAST HAMMER LANE Levek T <br /> JERRY UNRUH210 t <br /> FAX# AVG <br /> STOCKTONt CA 95210 US Levels <br /> VDetiignated Facility(Transport to) (pante&addri Ss) Facility Phonic# Facility Permit Numbers <br /> TPS TECHNOLOGIES INC. (510) 235-8778 <br /> Pcrson to Contact <br /> 20 RECYCLING LANE Cheron Rice/Don Murashima <br /> O FAX# <br /> k RICHMOND CA 94801 US (510) 231-4154 r <br /> Transporter Namc and Mailing Address j Transporter s Phone# Transporttr s US EPA ID No <br /> a LUTREL TRUCKING (805) 399-0246 <br /> 6315_ SHOW ROAD Person to Contact Transporter!,DOT No <br /> HERMAN <br /> ~ FAX# Customer Account Number with TPS <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% U <br /> 0-20% ❑ Diesel ❑ -)3( <br /> 0 <br /> 20%-over❑ Other ❑ <br /> .t <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ Z{ <br /> Clay ❑ Other ❑ 10-20% ❑ Diesel ❑ <br /> 20%-over❑ Other ❑ r <br /> List any exception to items listed above <br /> Generator's and/or consultant's certification I/We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing has been added or done to such soil that would alter it to <br /> any way l (— AAA <br /> Print or T pe Name Generator ❑ Consultant ❑ Signature and date Month Day Year <br /> 1 Dy o6 1-7 1160 <br /> Transporters certification I/We acknowledge receipt of the soil described above an certify that such soil is being delivered in exactly the same <br /> condition as when received I/We further certify that this soil is being directly transported from the Generation.$ite to the Designated Facility <br /> without off-loading,adding to,subtracting from or to any way delaying delivery to such rte <br /> to <br /> Pnnt or Type Nam Signature and dateML Day Year <br /> 1- <br /> a G , <br /> Discrepancies <br /> U <br /> to <br /> a <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> Pant or Type Name Signature and date ' <br /> 01V (Vk �'D-45 <br /> Plea!e print or type t <br /> P <br /> TPS INVOICING COPY <br />