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TPS Technologies Soil Recycling , <br /> anif est Non-Hazardous Soils ! ,." YMar#ifest; + E �~ <br /> 4fG,nLr <br /> e of Shipment Responsible for Payment Transpor�err'Ii�tck#_ f T, cility# Given by TPS Load# <br /> Z< 1Generator 0 00014 3 <br /> itor s N-imt and Billing Addrews G(n for s Phon(# Gen(rator s US EPA ID No <br /> ULTRAMAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET PLrson to Contact <br /> TERRANCE FOX <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 US (209) 583_3282 1002367 <br /> Comultint ti Namc. and Billing Addr(ss Comuitant s Phone# <br /> HORIZON ENVIRONMENTAL ( 1 ) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Person to Contalt <br /> SUITE 7 GARY BARKER <br /> FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 US (916) 939-2172 4 D IZ© <br /> G(n(ratlon Site(Transport from) (naim&address) Site Phone# BTEX r <br /> Levels " <br /> BEACON STATION #1-641 5133 32 " a, <br /> P(rson o pntact TPH <br /> ti `e 1210 EAST HAMMER LANE Levels <br /> JERRY I-INRIIH <br /> FAX# AVG <br /> Levels x <br /> zr s <br /> VDesignated Facility(Transport to) (name&addrt as) Facility Phone# Facility Permit Ntimb(fs rR ; <br /> ~ TPS TECHNOLOGIES INC. <br /> Person to Contact .. � <br /> 20 RECYCLING LANE Cheron Rice/Dor Murashima <br /> .� FAX# o- <br /> w <br /> RICHMOND- CA 94801 USA (510) 231-41544 , <br /> dTransporter Nam(and Mailing Addr(ss Transporter s Phone# Transporters US EPA IR No <br /> LUTREL TRUCKING (805) 399-024A4 <br /> 6315 SNOW ROAD Person to Contact Transporter s DOT No <br /> HERMAN <br /> FAX# Custom(r 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 Weight <br /> Sand ❑ Organic❑ 0-10% ❑ Gas f <br /> Clay U Other O 10-20% ❑ Diesel ❑ �(�t Z`l D 30 64c) <br /> c 9i 6c J M <br /> 20%-over❑ Other ❑ r <br /> Sand ❑ Orgamc O 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ 10-20% ❑ Diesel ❑ I S <br /> 20%-over❑ Other O <br /> List any exception to Mems listed above <br /> by <br /> Generator's and/or consultant's certification Il We certify that the soil referenced herein is taken entirely from those sods described in the Soil Data <br /> Sheet completed and certified by me/us for the Generation Site shoran above and nothing has been added or done to such soil that would alter it in <br /> anyway f"o <br /> A <br /> Print or Type Name Generalor ❑ Consultant ❑ Signature and date month Day <br /> Year <br /> EDhIlpOV' / _ <br /> Transporters certification IIWe acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same i <br /> t= condition as when received 11 We further certify that this soil is being directly transported from the Generation§ite to the Designated Facility <br /> hwithout off-loading,adding to,subtracting from or in any way delaying delivery to such site ` <br /> Pnnt or Type Name Signa re and date Month Day Year a <br /> Discrepancies <br /> LL <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> Print or Type Name Signature and datequ —De; /t, ( <br /> I <br /> rZ <br /> IPiease print or type , t <br /> '3 <br /> TPS INVOICING COPY <br />