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r <br /> TPS Technologies Soil Recycling <br /> r <br /> 1�Ianiest Non-Hazardous SoilsManifest#f Shipment Responsible for Payment Transporter Truck# Facility# Given by TPS Load# " <br /> E <br /> Generator ® 00014 2 <br /> Ff- �� <br /> Gencrttor N imp and Billing AddrL-ss GLnLmtor s PhonL# Genlfator s US FPA ID No <br /> ULTRAMAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET PenontoContact <br /> FAX# CustomLrAccount NumbLr with TPS 4 <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 , <br /> Consultant i Namc and Billing Addicss Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 f <br /> 5011 GOLDEN FOOTHILL PARKWAY PLrtion 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 /> R <br /> Generation Site(Tr inspoi t tram) (nnin&addreas) SILL Phonc# BTEX <br /> Levels <br /> BEACON STATION #1-641 ( 2019) 583-3247 '2 <br /> Person to Contact TPH <br /> 1210 EAST HAMMER LANE LevelsJERRY UN UH <br /> a <br /> FAX# AVG <br /> Levelh <br /> rn <br /> STOCKTON <br /> c CA 95210 US — <br /> UDesignated Facility(Transport to) (nanre£r addr(s,) Facility Phone# Facility PLrmit Numbers a <br /> o (510) 235-8778 �Q <br /> TPS TECHNOLOGIES INC. PLrsontoContact <br /> 20 RECYCLING LANE Cheron Rice/Don Mureshima <br /> FAX# <br /> a RICHMOND CA 94801 US (510) 231-4154 <br /> TransportLr Name and Mailing Address Transporter s Phone# TransportLr s US EPA ID No " <br /> LUTREL TRUCKING (805) 399-0246 <br /> 6315 SNOW ROAD <br /> PLison to Contact 't Transporter s DOT NoHERMAN <br /> y <br /> FAX# Customer Account Number with TPS <br /> BAKERSFIELD, CA 93308 4LUTREL i <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 ❑ �Ju _ <br /> 10-20% Q Diesel ❑ ?S CID 01) I -1 S <br /> Clay ❑ Other ID Diesel <br /> -over❑ Other ❑ ' rr <br /> Sand ❑ Organic❑ 0 10% ❑ Gas ❑ <br /> 10-20% ❑ Diesel ❑ 2 <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ i <br /> List any exception to items listed above <br /> + $r <br /> Generator's and/or consultant's certification IlWe certify that the soil referenced herein is taken entirely from those soils described in the Soil Data ' x <br /> Sheet completed and certified by me/us <br /> pforr the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way L-! Affi <br /> t <br /> Prmt or Type Name Generator ❑ Consultant ❑ Signatum an date Month Day Year i <br /> J�� 117 �L f <br /> Transporter's certification IlWe acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> ccondition as when received IlWe further certify that this soil is being directly transported from the Generation Site to a Designated Facility <br /> N without off-loading,adding to,subtracting from or in any way delaying delivery to such site v ; <br /> Y <br /> R Pnnt or T Name Signature and date Month Day Year <br /> L 1 f�: <br /> Discrepancies ` <br /> Lr�4 <br /> V � <br /> iy <br /> t Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above �r <br /> Pnnt or Type Name Signature ae_Cnd date <br /> Pt#sae print or type, F r' <br /> TPS INVOICING COPY <br />