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Jt l"�� TPST Safl Reyclers of CA n <br /> d t': <br /> Non-Hazardous Soils <br /> Facilit #: Given b TPST; Load# titer: <br /> Date of Shipment: Responsible for Payment: 'tk nspOrter Tkuc : ,/ y y <br /> 112 '/y/ A07 �J l 0 -r <br /> 11� I/ _ f <br /> Generator's Phone#: Generator's US EPA]D No. <br /> Generator's Name and Billing Address: 926-e42_6931 CAR000142670 <br /> CHEVRON ENVIRONMENTAL MANAGEMENT CO. Person to Contact: <br /> C/o CPOS WASTE DESK <br /> P.Q.8OX 8004 Customer Account Number with TPST: <br /> FAX#: - <br /> s SAN RAMON.CA 84683 <br /> s <br /> Consultant's Phone <br /> Consultant's Name and Billing Address: <br /> r� <br /> Person to Contact: <br /> I <br /> 3• FAX#: Customer Account Number with TPST: z' <br /> BTEX <br /> Generation Site(Transport from): (itame&oddrrss) Site Phone#: <br /> Levels <br /> PROPERTY INC 206387 <br /> TEXACO DOY STREAM PROP --- <br /> Levels, <br /> k., Person to Contact: TPH u <br /> Levels. <br /> {_= <br /> FORMER N. EDISON ST. <br /> v AVG, <br /> STOCKTON, CA 96208 FAX#: <br /> _ Levels z <br /> z, Facility Permit Numbers <br /> Facility Phone#: y � <br /> V Designated Facility(Transport to): 6tmrce&address) t: <br /> eaa e62-8001 <br /> TPST 501L RECYCLERS OF CALIFORNIA Person to Contact: <br /> s <br /> m 1232e Hi1315CUs AVENUE~ DELLENA.IEFE Ri;Y <br /> ADE ANTO,CA 92301 FAX#: <br /> y <br /> r780 2413-80CA <br /> a tTran otter's US EPA ID No.: <br /> Transporter's Phone#: <br /> Transporter NanW and Mailing Address: � <br /> 8d8-48p-5204 GAR000183813 ' <br /> SELSHI RE Person to Contact: Transporter's DOT No.: <br /> ' 4508A7 <br /> 268'71 TpWNE CENTRE DRIVE LARRY MOOTHART rt <br /> Customer Account Number with TPST: <br /> FOOTHILL RANCH,CA 82610 FAX#: ; <br /> t3ESI; 1134167 949-46n-6 10 <br /> cri tion of Sol!. Moisture Content Contaminated by: Approx.Qty: <br /> 0-10/ Gas 11 Description of Delivery Gross Weight Tare Weight Net Weight <br /> Des p <br /> ' <br /> L>t a q <br /> r� ry <br /> Sand ❑ Organic❑ 10-20-1. ❑ Diesel q C��'lt 5. -;'jC,��(� / -✓ /f K <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ l�1 tt Kz <br /> 0-1090 Q. Gas ❑ I ` <br /> Sand ❑ Organic O 10_20% ❑ Diesel Q <br /> " <br /> Clay ❑ Other ❑ 20°10-over❑ <br /> Other q <br /> ri Scale Ticket# �� s <br /> [Ssi any exception to items listed above: <br /> ,. <br /> Generator's and/or consultant's certification: I/We certii that the soil referenced herein is token entirely frons those soils describedat in the Soil it ta <br /> in <br /> E <br /> Sheet completed and certified by me/us far the Generation Site shown above and nothing has been added or done to such soiI'that would alter it in R. <br /> any way. Mon Day,. Year <br /> Consultant ❑ Signature d <br /> Print or type Natrie: Generator O <br /> € <br /> Larry Moothart of SESI on behalf of eneratoreing delivered in <br /> 73ansporter's certification: I/We acknoroledKe receipt of the soil des ed above and certify that such soil is bexactly the same '. <br /> C condition as when received. 1111efurther certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> 4 tracting from or in any way delaying delivery to such site. <br /> without off-loading,adding to,sub <br /> F — <br /> 14yn Da e r ;�a <br /> y r // S(gnature and d�te;�' y 1 <br /> � Pry e <br /> � Disaepanctes:������ <br /> � L1 <br /> f <br /> Recycling Facility certifies fire receipt of the soil covered by this manifest except as noted above: <br /> a Signature and date: � <br /> j, Print or Type Name-. I <br /> z; a D. JEFFREY/J. PROVANSAL <br /> r <br /> `�'`;�t�s y <br /> TRANSPORTER COY- " <br />