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TPS Technologies Soil Recycling a, <br /> Manifest Non-Hazardous Soils y manifest# 4;, <br /> Date of Shipment Responsible for Payment Transporter Truck ff Facility# Given by TI'S load# <br /> Generator 04 00014 037 <br /> Gencritor s N une and Billing AddrL�s Generator ti Phone# GenLrator s US EPA ID No r <br /> ULTRAMAR, INC. ' <br /> PLr%on to Contact <br /> 525 WEST THIRD STREET <br /> FA ERRANCE FOR C11StOMer Atcount Number Kith TPS <br /> HANFORD CA 93230 USA `* <br /> Consultant,,NamL and Billing AddrLss Consultant s Phone# <br /> HORIZON ENVIRONMENTAL <br /> Person to Contact <br /> 5011 GOLDEN FOOTHILL PARKWAY UARY BARKER = <br /> SUITE 7 FAX# Customer Account Number with TPS <br /> EL DORADO HILLS CA 95762 USA _ <br /> GcnLration SAL(Trampart from) (na)m£+address} Site Phone# BTEX <br /> LLvels <br /> BEACON STATION #1-641 PL o,taL TPH <br /> 12].0 EA5T HAMMER LANE Le-,els <br /> +t�+ FA #ERRY U N R U 11 AVG <br /> � r Levels <br /> t <br /> VDeignated F3ctlity(Transport to) (iconic&address} Fact ity hone# Facility Permit Numbcra <br /> TPS TECHNOLOGIES INC. PLrson to Contact <br /> 20 RECYCLING LANE Cheron Rice/Don Murashima <br /> Q FAX# `x <br /> a - <br /> Transporter Name and Mailing Add rLis Transporter s Phone# Transporter s US EPA ID No r <br /> LUTREL TRUCKING (80511- 399-0749 <br /> 6315 SNOW ROAD Pcrson to Contact Tran%porter s DOT No <br /> HERMAN <br /> FAX# CustomLr Account Number with TPS <br /> BAKERSFIELD, CA 93308 4LUTREL r <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 ❑ G <br /> 00 Z 9'u 4;' <br /> 410-20% ❑ Diesel ❑ <br /> Clay ❑ Other fl <br /> 20%-over❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other ❑ 10-20% ❑ Diesel ❑ <br /> 20%-over❑ Other ❑ <br /> Last any exception to items listed above <br /> Generator's and/or consultant's certification Il We certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and certified me/us.four the Generation Site shown above and nothing has been added or done to such soil that would alter it to <br /> any way A6W %.i .e. M <br /> Pant or Type Name Generator ❑ Consultant ❑ Signa re and date Month Day no etbE7 byw�r, I -�e_". A �& I r <br /> Transporters certification I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> ocondition as when received IIWe further certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> Pnnt or pe Name Signature and date Month Day QYear <br /> /L 7-W Q//L L/1/1-0 L I <br /> Discrepancies <br /> ti <br /> V <br /> O <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above t <br /> � Pant or Type Name Signature and date <br /> Crease print or type " <br /> i r <br /> TPS INVOICING COPY <br />