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,� TPS Technologies Soil Recycling <br /> , ► c �i est Non-Hazardous Soils Minifgst# <br /> F4 I <br /> Date of Shipment. Responsible for Payment Transporter Truck# Facility# Given by TPS Load# <br /> Generator 3? 0 00014 3 <br /> Ge ntrator s lame and Billing Addresti Gen rator s Phone.# Generator s US EPA ID No , <br /> ULTRAMAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET 1'Lr% ntoContact � <br /> TERRANCE FOX <br /> FAX# Customer Account Number with TPS �+ <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consult-int s Name-ind Billing Address Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY PLrson 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 /> Gtnerahon Sik(Transport from) (narrn Ps address) Sitc Phone# BTEX <br /> Levels a <br /> BEACON STATION #1-641 — <br /> Pcrson to Contact TPH <br /> 1210 EAST HAMMER LANE Levels <br /> ' FAX# AVG <br /> STOCKTON CA 95210 USA Levels ' <br /> UDesignated Facility(Transport to) (pante&addri, s) Facility Phone# Facility Permit Numbers <br /> c TPS TECHNOLOGIES INC. (510) 235-8778 <br /> Person to Contact <br /> 20 RECYCLING LANE Cheron Rice/Don Mureshima <br /> KA <br /> ,D FAX# <br /> ;P RICHMOND CA 94801 US (510) 231-4154 <br /> »q <br /> ' y 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 Transporter s DOT No <br /> HERMAN <br /> FAX# Customer Account Number with TPS <br /> BAKERSFIELD, CA 93308 4LUTREL <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 ❑ <br /> 10-20% ❑ Diesel ❑ j <br /> Clay LJ Other ❑ 20%-over ❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ <br /> 10-20% ❑ Diesel ❑ �l 1 <br /> 201/.-over❑ Other O <br /> List any exception to items Lsted above <br /> r <br /> Generator's andlor consu'ltant's certification I/We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data <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 way <br /> 1'nnl or Type Name enerator ❑ Consultant ❑ Signature and da Month Day Year Y <br /> 1 Ota � <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 /> condition as when received I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> H without off-toadmg,adding to,subtracting from or in any way delaying delivery to such site <br /> Fruit or Type Namere and date Month Day Year Y/e/a�r, j <br /> F' ! ; <br /> screpancies 't <br /> a <br /> k <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> Signature and date � <br /> �, Trent or Type Name <br /> � IVVV ra ftt4tilt k- RVI s <br /> Please print or type j <br /> TPS INVOICING COPY <br />