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TPS Technologies Soil Recycling <br /> a Maife,4t- - - Non-Hazardous Soils �n +�' Manifest# <br /> �n � o <br /> D to Shig nt Responsible for Payment Transporte Track# Facility# Given by TPS _ Load# iY <br /> Gene�ratar 04 00014 3 , <br /> Gcncr itor N-imc and Billing Addres, Generator s Phonc# Generator s US EPA 1D No <br /> ULTRAMAR, INC. <br /> Person to Contact <br /> 525 WEST THIRD STREET <br /> FA Customer Account Number with TTS <br /> HANFORD CA 93230 USA _ <br /> Con�ult-int N Nanic-ind Billing,Addresd Consult int s Phone# <br /> HORIZON ENVIRONMENTAL <br /> Peron to Contael <br /> 5011 GOLDEN FOOTHILL PARKWAY GARYBARKER <br /> SUITE 7 FAX# Customer Account Numbcr with TPS <br /> EL DORADO HILLS CA 95762 IDSA _ AunpT 7-n <br /> Gcncrahon Site(Tru,sport from) (nine£addrens) Site Phonc# BTEX <br /> Levels <br /> BEACON STATION #1-641. Per o,tac TPhi <br /> 1210 EAST HAMMER LANE Levels <br /> +� FA # AVG <br /> NLevels <br /> C°) DL. ignited Facihh (Transport to) (nnre£r addn Fatly hone.it Facility Permit Numbers R <br /> ° TPS TECHNOLOGIES INC. r <br /> Person to Contact x <br /> 20 RECYCLING LANE Cheron Rice/Don 'Murashima <br /> O FAX# <br /> t# <br /> —41 ci4 -j <br /> Transporter Name and Mailing Address Transporter s Phonc# Tranbporter's US EPA 1D No <br /> LUTREL TRUCKING (805) 399-0746 <br /> Person to Contact Transport"'%%DOT No <br /> 6315 SNOW ROAD <br /> e FA Customer Acco-ant Number with TPS <br /> BAKERSFIELD CA 93308 4LUTREL f <br /> DescAption of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Gross Welght Tare Weight Net Weight <br /> Sand U0-10%Organic❑ ❑ Gas ❑ i <br /> -o 10- <br /> Clay LJ Other ❑ ❑ Diesel ❑ O <br /> 20`7-over❑ Other ❑ 4}" <br /> 0-10% ❑ Gas ❑ <br /> Cly ❑ Other d u is 1310-20% ❑ 'Diesel ❑ f <br /> 20%-over d Other ❑ <br /> List any e7D:eption to items listed above <br /> t <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 byme/us for the Generation Site shown above and nothing has been added or done to such soil that would alter it in i <br /> any way QC�,4T G pu j. AMA e b <br /> Print or Type Name Generator ❑ Consultant ❑ Signature and dot Month Day Year <br /> q6 <br /> Transporter's certification I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same s <br /> t° condition as when received IIWe further certify that this soil,is being directly transported from the Generation Site to the Designated Facility t <br /> without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> Pant or pe Name Signatu d date Month Day Year i <br /> L s <br /> 1, <br /> Discrepancies <br /> C Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> Pant or Type Name Signature and date <br /> V <br /> orJ <br /> Please print or type <br /> TPS INVOICING COPY <br />