Laserfiche WebLink
s TPS Technologies Soil Recycling Y <br /> " Milnlfest Non-Hazardous Soils ` Manifest 4 <br /> Date of Shipment Responsible for Payment Transporter Truck# Facility# Given by TPS Load# <br /> Generator JAI Ion 00014 q2 <br /> Gcnir;tor s Namc and Billing AddrL%% Guneritor s Phone# Generator s US EPA ID No ' <br /> UL'TROAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET PiM011toC011tact �. <br /> TERRANCE FOX <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consultant s Name and Billing Addrtss Con wItant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Person to Contact <br /> SUITE 7 GARY BARKER <br /> FAX# Customi,r Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US939-2172 4HORIZO <br /> Generation Site(Transport from) (nam,&address) Site Phone# BTEX pa <br /> P� <br /> BEACON STATION *1-641 levels <br /> Person o on ct TPH <br /> �s 1210 EAST HAMMER LANE Levels j <br /> " FAX# AVG <br /> f <br /> y LevelsqTnr.jj-T-ON. -CA (392110 USA <br /> „f <br /> 1~ 4age; 062 <br /> VDesignated Facility(Transport to) (name&address) Facility Phone# Facility Permit Numbers d <br /> ° TPS TECHNOLOGIES INC. (510) 235-877A <br /> yy � Person to Contact <br /> f 20 RECYCLING LANE Cheron Rice/Dor Murashima <br /> L <br /> FAX# <br /> °ems asRTr-HM13KD. CA 94801 USA (510) 231-41 4 <br /> Transporter Name and Madmg-Aadress Transporter s Phone# Transporter s US EPA ID No nt <br /> Al" LUTREL TRUCKING399-0 49 <br /> 6315 SHOW ROAD Person to Contact ransporter a DOT No <br /> FAX# ]Customer Account Number with TPS <br /> BAKERSFIELD, CA 93308 4LUTREL ' <br /> Description of Soil Moisture Content Contaminated by Approx City Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ Organic Cl 0 10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ <br /> 10-20% ❑ Diesel ❑ <br /> y 20%-over ❑ Other ❑ <br /> Sand ❑ Ormc❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ O r ❑ 10-20% ❑ Diesel ❑ <br /> 20%-over❑ Other Ll <br /> List any exception to items listed above `= <br /> x <br /> Generator's andlor consultants 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 me/us for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way 46aoT IV (11 3fMAL <br /> print or Type Name Generator ❑ Consultant ❑ SIV31.r,�and de Month Day Year <br /> f .N �a+,i�t�� 0&1/7 `76 <br /> L. Transporter's certification Il We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> ccondition as when received I/We further certify that this soil is being directly transported from the Generatmn Site to the Designated Facility <br /> H without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> sx <br /> Pint or Type Name , Signature and date MonthDay Year �p <br /> a <br /> Discrepancies <br /> w <br /> to <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> t] Print or <br /> ]� Type Name Signature and date, ` <br /> Please print or type r <br /> TPS INVOICING COPY ' <br />