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n <br /> =-i7_7 <br /> L SAFE OF CA — `� IS <br /> X.-ani =- Non-Hazardous Soils ' <br /> — <br /> Date of Shipment: Responsible fee Payment Transport Truck N: Facility#. ApxovaI Nu bee. i oa <br /> to s Name and Bin Address: <br /> Generator's Phone N: <br /> Genera r' Billing _ <br /> ` r <br /> r•,r - <br /> SJ R-�.. <br /> 8—'NEST COAST PRODUCTS. LLC; <br /> 4.0. Box 80249Person to Contact: <br /> RA14C:HG -SANTA M4 ,JRC:.f�.F�iT1 CA 22688 <br /> FAXN- Customer Account Number <br /> Consuttant's Name and Billing Address: Consultant's Phone{I: <br /> Person to Contact: - <br /> FAXit: Customer Account Number ` <br /> Generation5ite(Czansportfrom):(name&address) Site Phone tf: <br /> = FORMEP, ARCO 1;Pa" <br /> $202104 HAMMIER 1-4,E to Contact: x <br /> r SI OCKTON. CA 21'5208 y <br /> PAX#: <br /> o - <br /> Q Designated Facility(transport to):(mine&address) Facili Phone <br /> SOIL SAFE <br /> 12325 HIBISCUS AVENUE PersentoContact: m i3ELLENa--C-.2=PREY <br /> ti hLELAI�ITO, CA 0231DI <br /> FAX#.- <br /> i_; (760)240 <br /> Transporter Nae and Mallin Address: Trani rice s.Phone M <br /> c� �° msa2�a car 0001 s3 i1 , r <br /> t _ <br /> S1=iwSH1RE <br /> "N 26971 T0YA4IE CENTRE DRIVE Person to Contact: f <br /> - FOOTHILL RAKCH, CA 52640 LORRY l�EC70ThRf�T50C7 s <br /> bEsI: 20122Q FARC CastomerAccount Number <br /> 94"BO-5210 <br /> Y4 b • A rox. t : Description of Deliver Grass Weight Tare Weight Net Weight <br /> _ <br /> Description of Soil Moisture Content Contaminated y. pp iii y p y 9 9 9 <br /> 0-10% O Gas ❑ r'e <br /> ClayOrganic <br /> ❑ Other 0 10-20% ❑ Diesel Q <br /> 3 20%-over Q Other ❑ <br /> o-16% ❑ Gas Q <br /> O Organic D 10-zow o <br /> - Sand g <br /> - Diesel 4 4% <br /> nLL Clay❑ Other Q 20%-over 0 Other ❑ �44S•tList any exceptio �itgmsl t bov ScaleTicket# <br /> Generator's and/or consultant's certification:I/We certify that the soil referenced herein is taken entirely from those sails descried in bit S rl <br /> shown above and nothin lois madded or done to such soil that would alte <br /> Sheet completed and certified by ine/us for the Generation Site t g <br /> _�- <br /> in any way. <br /> Print or Type Name: Generator D Consultant ❑ Signature and date: Moth Day Y ar , <br /> Lamy Moothart of BES! on b6haif of pener;t � � P � Rf <br /> Transporter's certf cation:I/We acknowledge receipt of the soil referenced above and certify that such soil is being delivered in exactly the same <br /> j condition as where received.Mefurther cern that the soil is beim directly transported oin the Generation Site to the Designated Facility <br /> rz <br /> o l� � �J g y F �' gn tJ <br /> X without off-loading,adding to,subtracting from or in'any way delayin delivery to such site. <br /> y , <br /> Pnnf or Type Name:. t Signature nd date_W; <br /> Mont D y e <br /> Discrepancies: :,; <br /> tX <br /> Recycling Facility certifies the receipt of the soil covered by this nrani t except as rioted above: <br /> VPrint or Type Name: Si aturetand date: f <br /> CCi}. LIwFFFtiw'S'IJ. Pi���V;itilSaL <br /> PJesS��t[J[i1 P�tyRe�t F '�,�,..�� —•-� �_� _- - <br />