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1V/ !. VV lUL LS LV 1(116. IlY SVV 111 L L u 1 W..i VV I.. <br /> h <br /> + -TPS Technologies Soil R&3(dirig <br /> Non-Hazardous Soils <br /> Date of Shipment Responsible for Payment Transporter Truek# Facility it GivenbyITZ45-D <br /> Load <br /> EE #� <br /> 09/10/98 LSRIRE - <br /> Generator s Name a i dr Generator s Phone it Generator s US EPA YD No <br /> 102 rccuburg Read <br /> Suite #470 Person to Contact <br /> Portland. OR 97233 <br /> FAX# Customer Account Number u ith TPS <br /> Consultant's Name and Billing Address Consultant s Phone# <br /> Person to Contact <br /> FAX# Customer Account Number with TPS <br /> Generation SSite( r :iort 13 (same&address) Site Phone# BTEX <br /> Levels <br /> 4501 N. Pershing AMC. Person to Contact TPH <br /> StOCii;tona CA Levels <br /> C <br /> w FAX# AVG <br /> S Levels <br /> N <br /> C <br /> U Designated Fac i ��Trcans rt to) (i me&dddress) Facility Phone N Facility Permit Numbers <br /> 12 2i hibiscus Ave. <br /> Ade t unto. CA 92301 Person to Contact <br /> C <br /> C0 <br /> FAX# <br /> 4 <br /> L <br /> m <br /> C Transporter Name and Marling Address Transporter s Phone# Transporter s US EPA ID No <br /> 25422 Tratyueo Rd- >1k105-269 Person o o tar Transporter s DOT No <br /> El Toro, CA 92630 <br /> 8.E.S. I .#19220.02 FAX# Customer Account Number with TPS <br /> Description of Soli Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> sand Cl organic❑ 0-10% ❑ Gas ❑ i ` <br /> 10-20% Q Diesel ❑ 94 <br /> Clay ❑ ocher ❑ 71%-over COther ft <br /> ❑ <br /> $and ❑ Organic q 1 201 Gas O <br /> Clay ❑ other ❑ 20 24% U Diesel O i <br /> 2096-over O Other d <br /> List any exception to items listed above <br /> 4 v <br /> Generator's and/or consultant's certification [/We certify that the soil referenced herein is taken entirely from those soils described to 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 /> r any way <br /> Print or Type o u t Signature and date• Month Day Year <br /> Y'& <br /> Transporter s certification I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> ccondition as when received I/We further certtb 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 fo ch site <br /> I-- Print orType Narne Signature and S My th Day Year <br /> Discrepancies - <br /> � s <br /> ti 4 <br /> rZRecycling Facility certifies the receipt of the soil covered by this manifest except as noted abate <br /> Print or Type Name Signature and date i <br /> Z(� Ict <br />