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TPS Technologies Soil Recycling - <br /> Manifest Non-Hazardous Soils $ ' ; 4- Manifest * 4, <br /> Date of Shipment Responsible for Payment Transporter Truck th Facility# Given by TPSLoad# <br /> ' Generator 3 C> 0 00014 2 ' <br /> Generator ti Ntmc and Billing Add t i- <br /> b Generator s Pituiti # GEncrator s US EPA ID No t <br /> ULTRAMAR, INC. (209) 581-5545 ,.' <br /> 525 WEST THIRD STREET PcruintoContact <br /> TERRANCE EON <br /> rAX# CnStnmer Account Number with TPS t <br /> HANFORD, CA 93230 US (209) 5B 82 1002367 <br /> Consultant s Naml and 7111ing Addmss Consultant s Phone# <br /> HORIZON ENVIRONMENTAL 1' <br /> 5011 GOLDEN FOOTHILL PARKWAY Person to Contact <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US <br /> Generation Site.(Transport from) (nam(&address) Site Phone# BTEX „ <br /> Levels <br /> BEACON STATION #1-641 ' <br /> rr Person o on act TPH <br /> 1.2 .0 EAST HAMMER LANE Leets <br /> ` --JERRY UNRUH <br /> Q E <br /> l , FAX# AVG <br /> y 1 Levels <br /> C <br /> VDL-,%nated Facility(Transport to) (name£s addreS>} Facility Phone# Facility Permit Numbers <br /> ° TPS TECHNOLOGIES INC. — <br /> Person to Contact f <br /> 20 RECYCLING LANE Cheron Rice/Dor Kuraehima <br /> � w r FAX# <br /> Ripmomp.tea � <br /> k"w . <br /> Transporter Name and Mailing Address Transporter's Phone# Transporter's US EPA ID No �a <br /> LUTREL� TRUCKING . (805) 399-0249 <br /> 6;15 aS�OW ROAD Person to Contact Trinsporter s DOT No <br /> 1f f <br /> FAX# Customer Account Number with TPS <br /> �4 BAKERSFIELD, CA 93308 4LUTREL <br /> Description of Soil Moisture Content Contaminated by Approx Oty Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ Organic❑ 0-10% Q Gas ❑ - <br /> Clay ❑ Other ❑ 20%Z over❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ 10-20% ❑ Diesel ❑ <br /> 20%-over❑ Other ❑ r/ ¢ <br /> List any exception to items listed above 7 <br /> Generator's and/or c$nsultant's certification IIWe certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed an certifted bytneluts�f�or the Generattoite shown above and nothing has been added or done to such soil that would alter it in <br /> any way <br /> Print or Type Name Generator ❑ Consultant ❑ ST. re and �e Month Day Year <br /> ! <br /> 1 �D .c � oc� [Tt <br /> Transporters certification IIWe acknowledge receipt of the soil described above and certig that such soil is being delivered in exactly the same <br /> ocondition as when received IIWe further certify that this soil is being directly transported fro' t*e Generation Slte to the Designated Facility <br /> y without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> Print or ame Signature an ate Ma th 'ay Year f <br /> Discrepanctes <br /> � �S <br /> roV <br /> Recycling Facility certifies the receipt of the sod covered by this numifest except as noted above y re <br /> print or Tyle Name Signature and Adate I r 4» <br /> 1 <br /> Please print or type YYY r <br /> TPS INVOICING COPY <br />