Laserfiche WebLink
TPS Technologies Soil Recycling <br /> Manifest Non-Hazardous Soils 4o Manifest# 4, H<z <br /> Date of Shipment Responsible for Payment Transporter Tru # Facility# Given by TPS Load# <br /> Generator �3� 04 00014 3 <br /> Ccncrator s N-imc and fulling,Address Gc Lritor s Phone# GLnLrator s US EPA ID No ? <br /> t <br /> ULTRAI7AR, INC. - <br /> 1 Lrson to Contact <br /> 525 WEST THIRD STREET <br /> ERRANCE FOX <br /> FAX# CUStOn7Lr Account Number with TPS <br /> HANFORD CA 93230 USA <br /> Consult-int s NamL and Billing Addn ss Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (911A) Q39-2170 <br /> PcrsUn to Contact <br /> 5011 GOLDEN FOOTHILL PARKWAY GARY BARKER <br /> SUITE 7 FAX# CustomLr AcLount Number with TPS <br /> EL DORADO HILLS CA 95762 USA <br /> Guicration Site(Transport from) (name tr address) Site Phonc# 6TEX <br /> Levels <br /> BEACON STATION #1-641 Pers o to TPH <br /> 1210 EAST HAMMER LANE Le`els UNRUH <br /> *gam <br /> FAR Ar <br /> AVG <br /> Levels <br /> C <br /> V Designated Facility(Transport to) (name&addreSs) Faci t ne# Facility Permit NumbLrs(rilih) 235-8778 <br /> t <br /> TPS TECHNOLOGIES INC. Person to Contact <br /> ' 20 RECYCLING LANE r <br /> O FAX# <br /> to ' <br /> aTelux"N", GA W4904 <br /> Transporter Name an Mailing Address Transporter s Phone# Transporter s U5 EPA Ip No <br /> LUTREL TRUCKING <br /> Person to on, Transporter s DOT No <br /> 6315 SNOW ROAD <br /> FA Customer Account Number with TPS <br /> BAKERSFIELD CA 93306 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 U <br /> Clay ❑ Other ❑ 10-20% ❑ Diesel ❑ 6 0 900 J� a <br /> 20%-over❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ 1 3 <br /> 10-26% ❑ Diesel ❑ <br /> Clay Ll Other O 20%-over 0 Other ❑ <br /> List any exception to items luted above <br /> Generator's and/or consultant's certtftcatcon I/We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data `a <br /> Sheet completed and cera ed by me/us for the Generatt n Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way 60 IV W ` <br /> Print or Name Generator ❑ Consultant 13Si ie and dat Month Day Year <br /> w lu q <br /> Transporter's certification I/We acknowledge receipt of the soil described above and ertify that such soil is being d4tvered in exactly the same <br /> ocondition as when received I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> y without off-loading,adding to,subtracting from or in anyway delaying delivery to such site <br /> Print or Type Name 5rgnatu rid d e ' Month Day Year < <br /> ra <br /> Discrepanoes ' <br /> V <br /> F <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above r <br /> Priinn't�oorr/TJylm��Name Signature and date ` r <br /> Please print or type 4 <br /> TPS INVOICING COPY <br />