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TPS Technologies Soil Recycling <br /> ,yManifest Non-Hazardous Solis 4; Manf6st`# y ° , <br /> Date of Shipment Responsible for Payment Transporter Truck# Facility# Given by TPS Load# <br /> Generator „3 0 00014 3 <br /> Gc aerator s Name and Billing Addi-E%,, Gene ator s Phone# Guurator s US EPA ID No ' <br /> ULTRAMAR, INC. 583-5545. <br /> 4525 WEST THIRD STREET _ PcrynntUContact <br /> TERRANCE FOX <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 US J, <br /> (209) 583--3282 1002367 <br /> Consultant 5 Name and Billing Address Consultant s Phone# a <br /> HORIZON ENVIRONMENTAL ) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Peron to Contact <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TPS , <br /> EL DORADO HILLS, CA 95762 USA, (916) 939-2172 4LURI130 <br /> Generation Site(Transport from) (na)m&address) Silt-Plufne# BTEX <br /> Levels <br /> BEACON STATION 01-641 Pcrson on aet 589 324" <br /> 'I PH { <br /> 1210 EAST HAMMER LANE Levels <br /> FAX# AVG <br /> {P3Levels # <br /> VDesignated Facility(Transport to) (name Ly addrtGs) Facility Phone# Facility Permit Numbers <br /> ° TPS TECHNOLOGIES INC. — <br /> 8778 <br /> Person to Contact <br /> 20 RECYCLING LANE <br /> Cheron Rice/Dor Muraehima <br /> .q FAX# <br /> RICH 94801 USA (510) 231-415 <br /> � � w <br /> 4i <br /> Transporter NaML-ind Mailing Address Transporter s Phone# Transporter s US EPA ID No <br /> LUTREL TRUCKING399-0246 <br /> 6313 SNOW ROAD Person to Contact Transporter s DOT No <br /> HERMAN <br /> FA X# 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 Weight3welghtSand ❑ Organic❑ 0-10% ❑ Gas ❑ 3Z S6'jCiay ❑ Other ❑ 10-20% ❑ Diesel ❑ J20%-over❑ Other ❑Sand ❑ Organic❑ 0-10% ❑ Gas ❑Clay ❑ Other ❑ 10-20% ❑ Diesel G 20%-over❑ Other ❑ <br /> Lot any exception to items listed above <br /> Generators and/or consultants certification IIWe certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and certified by melus for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way u�.'�'4 a <br /> Print or T Name Generator ❑ Consultant ❑ Slnattire and date Month Day Year <br /> Transporters certification IIWe acknowledge receipt of the soil described above and certify 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 Site to the Designated Facility <br /> y41 without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> Print or Type Name _ Signatu and te!" Mon h Day Year x` <br /> Discrepancies Ur <br /> c . <br /> ILL <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> lV Print or <br /> � Type Name r Signature and date k� <br /> Sv G j rvc ti 'b r7 56 <br /> Waris print or type •ti <br /> TPS INVOICING COPY <br />