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TPS Technologies Soil Recycling <br /> Manifest Non-Hazardous Soils � Manifest# P� � 3 <br /> Date of Shipment Responsible for Payment Transporter Truck# Facility# Given by TPS Load# , <br /> Generator ? 0 00014 931 <br /> i <br /> Gcni rator s Namc and Billing Address do Gantrator s Phone# Gcncsator s US EPA ID No <br /> ULTRAMAR, INC. (209) 583--5545 <br /> 525 WEST THIRD STREET FUOn to Contact <br /> TERRANCE FDX � <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 .US <br /> {209) 583-3282 1002367 , <br /> Comultant ti Name and Billing Addri ss Consult-int 5 Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY P r�ontoContact <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US (916) 939-2172 4HORIZO <br /> Gencratton Sitc (Transport from) (naint&address) Site Phone# BTEX <br /> BEACON STATION #1-641 Levels <br /> Person to Contact TPH ; <br /> Q 1210 EAST HAMMER LANE ERRY UNRUH Levels <br /> w FAX# AVG ' <br /> STOCKTON,CA � 95210 US — 1 evels <br /> Cal Detiignatcd Facility(Transport to) (dame&addre,b) Facility Phone# Facility Permit Number <br /> c TPS TECHNOLOGIES INC. (510) 235-8778 ` <br /> Person to Contact <br /> 20 RECYCLING LANE Cheron Rice/Dor Murashlma <br /> o " <br /> FAX# ey <br /> RICHM OHDo, CA 94801 US (510) 231-4154 ; <br /> Transporter Name and Mailing Address Transporter s Phone# Transporter s US EPA ID No <br /> LUTREL TRUCKING � (805) 399--0246 <br /> 6315 SNOW ROAD Person to Contact Transports r s 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 Weighs <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other Lk 20% <br /> -20% ❑ Diesel ❑ 7� If� ��i 1 ! J 44 4W <br /> 20%a-over❑ Other ❑ 1 Y� t <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ r <br /> Clay ❑ Other ❑ 10-20% ❑ Diesel ❑ r`3 <br /> 20%-over❑ Other ❑ 1` <br /> List any exception to items Listed above <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 4 <br /> Sheet completed and certified by mews for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any wayNag� Me al-72AInd <br /> , <br /> Print or T Name Generator ❑ Consultant ❑ Si tum and date Month Day Year <br /> t t o� r 7 '4 <br /> t; <br /> Transporter's certification Il We acknowledge receipt of the soil described above and c rhfy that such soil is being delivered in exactly the same <br /> ccondition as when received IIWe further certify that this soil is being directly transported from the Generation Shite to the Designated Facility <br /> y without off-loading,adding to,subtracting from or in any way delaying delivery to such site 4i <br /> Print or Type NameSignature an date Month Day Year <br /> 4'r <br /> Discrepancies t <br /> U <br /> Recycling Facitity certifies the receipt of the,sail covered by this manifest except as noted above <br /> v <br /> Print or Type Name ( Signature <br /> eaand <br /> /date / 1 <br /> Cc <br /> .Please print or type <br /> TPS INVOICING COPY <br />