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TPS Technologies Soil Recycling i <br /> A. <br /> "Manifest Non-Hazardous Soils Manifest# <br /> Date of Shipment Responsible for Payment 77ransporter Truck# Facility# Given by TPS Load# <br /> lij <br /> Generator 04 00014 4 <br /> GLiicritor s Name ind IIillinf,Addres, Gcncrator c Phone# Generator s US EPA ID No <br /> ULTRAMAR, INC. PcrsnntoContaet <br /> 525 WEST THIRD STREET <br /> FA # CubtornLr Account Number x ith TPS <br /> HANFORD CA 93230 USA <br /> Con4ult-nt 5 Namc.Ind Billing Address Consultant s Phone# <br /> HORIZON ENVIRONMENTAL - <br /> 9170 <br /> Person to Contact <br /> 5011 GOLDEN FOOTHILL PARKWAY OARY BARKER <br /> SUITE 7 FAX# Customer Account Number with TPS <br /> EL DORADO HILLS CA 95762 USA e <br /> Gi-nc.ration Sitc(Trampart from) (na)M&address) Site Phone# BTEX a <br /> Levels t <br /> BEACON STATION #1-641 Pcrsc Oita - TPf1 <br /> 1210 EAST HAMMER LANE Levels <br /> AVG <br /> f Levels <br /> y <br /> 0 V Designated Facility( ransport to) fn rme u addre as) Faci i y hone# Facility Permit Numbers <br /> TPS TECHNOLOGIES INC. Person to Contact <br /> 20 RECYCLING LANE <br /> gyp+ FAX# <br /> a <br /> x Transporter Narneana Mailing Address Transporter s Phone# Transporter`s US EPA ID No <br /> LUTREL TRUCKING (905) 399-0246 <br /> Pcrson to Contact Tr-in5porter s DOT No <br /> 6315 SNOW ROAD <br /> FA CU5tamer Account Number with TPS <br /> BAKERSFIELD CA 93308 4LUTREL <br /> Description of Soli Moisture Content Contaminated by Approx Oty Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand O Organic❑ <br /> 0_10% ❑ Gas ❑ n <br /> 10-20% ❑ Diesel ❑ �t1 6�-o 32,�?'L? <br /> Clay ❑ Other U 20%-over Cl Other ❑ <br /> Sand O Organic❑ 0-10% ❑ Gas ❑ <br /> 10-20% D Diesel ❑ 2y <br /> Clay ❑ Other ❑ 20%-over❑ Other Q <br /> List any exception to items listed above <br /> Generator's and/or consultant's certification 1lWe certify that the soil referenced herein is taken entirely from those sorts described in the Soil Data <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> anyway q AmAe_ <br /> Print or Type Name Generator 0 Consultant O Si tugr xe and date Month Day Year <br /> Transporter's certification IlWe acknowledge receipt of the soil described above and cer ify that such soil is being delivered in exactly the same <br /> acondition as when received IlWe further certify that this soil is being directly transported from the Generation Site to the Designated Facility { <br /> H without off-loading,adding to,subtracting from or in any way delaying delivery to such site " <br /> Print or Type Name Signature a date' Month Day Year 1 <br /> Discrepancies <br /> a� <br /> V <br /> al <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> R, Print or Type Name Signature and date '� <br /> ,l { - H <br /> {iY(avit1V)A'V)1 ,( <br /> Please print or tytpe, A <br /> TPS INVOICING COPY <br />