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Manifest <br /> TPS Technologies Soil Recycling <br /> anifest Non-Hazardous Soils z 4, Manl#est# y e �� <br /> nit Date of Shipment_ Res onsible for Payment Transporter Truck# Facility# Gwen b TPS Load# <br /> �enerstor —, 04 00614 34 ;a <br /> Gel+�rw�t 111 y 1 i3€ll,n..A.jdn�ti "_Ti t66 Phob63-5545 GEncrator s US EPA ID No <br /> 5251 WEST THIRD STREET 1'Lr�onttOCo1),taLt <br /> TERRANCE FOX _ <br /> ,t <br /> HANFORD, CA 93230 USA FAY209) 583-3282 Cuse1,66 �iimber with TPS <br /> _VOTA&II"ENTAL Coty5ultn�s)P� ho919-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY l`� <br /> PetB,AR4'n,tff1kRKER <br /> SUITE 7 <br /> EL DORADO HILLS, CA 95762 USA FAI"916) 939-2172 Custoplff6rr12ek'rn`rwith TPS <br /> Gcm-ration Site(Transport from) (name£r rrddre�s) Site Phonc# 13TEX <br /> BEACON STATION #1-641 (209) 583-3247 L€.vels <br /> 1210 EAST HAMMER LANE PLrson to Contact TPH <br /> �., JERRY UNRUH Levels <br /> c � <br /> AVG <br /> STOCKTON, CA 95210 USA F`�(209) 583-3282 Levels <br /> VDesignated Facility(Transport to) fimme&addr€s�) Fac€1€ Phage#235-8778 Facility Permit Numbers <br /> TPS TECHNOLOGIES INC. (( 1(O! "{ <br /> 20 RECYCLING LANE pLrCbIdai16 Ft Rice/Don Muraehima <br /> RICHMOND, CA 94801 USA FA11510) 231-4154 14 <br /> m � <br /> Tra�is�ietluQLue ai l € ft&ss Tragsar t41� Pht�AW, —0246 Transporter's US EPA 1D No <br /> 6315 iiKK��++SHOW ROAl1DYI] Pell C�StkQ�WO, Transporter s DOT No <br /> BAKERSFIELD, CA 93308 FAx# Custo4+XUij!fiEbjumberwith TPS <br /> Description of Sod Moisture Content Contaminated by Approx QtyDescription of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ _ <br /> 70-20% 1:1 Diesel Q y <br /> Clay ❑ Other ❑ 20%-over ❑ Other Q ,bU �r3 l #�` <br /> Sand ❑ Organic❑ 0 10% ❑ Gas Q Z y <br /> 10-20% ❑ Diesel a <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ <br /> z� <br /> List any exception to items fisted above .ri�xg <br /> Generator's andlor consultant's 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 me/us for the Gio Site shown above and nothing has been added or done to such soil that would alter it in <br /> anyway <br /> Print or Type Name Generator 0 Consultant ❑ Signature and date Month Day I Year <br /> Transporter's certification I/We acknowledge receipt of the soil described above and certify that such soil is bewig delivered in exactly the same <br /> ocondition as when received IIWe further certify that this soil is being directly transported from the Generation 4rte to the Designated Facility <br /> H without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> � Pim r Type Name Signa and dateMonth Day Year <br /> 6 1 121 /291 <br /> Discrepancies <br /> ll� <br /> n� <br /> to �q <br /> lir > 4 <br /> R^ <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> Print or Type Name Signature and date <br /> s - <br /> °� �� #`111„ � aS�„�,�• � � �`v�� b ��- 5 �- <br /> Please print or type <br /> TPS INVOICING COPY <br />