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TPS.Technologies Soil Recy*g <br /> Non-Hazardous Soils <br /> Date of Shipment: Responsible for Payment: Transporter Truck# Facility#: Given by TPS: Load# <br /> Generator A09 00E41 0 1 <br /> Generator's Name and Billing Address: Generator's Phone#: Generator's US EPA ID No. <br /> Arco Products Co. (525) 299-8871 <br /> P. O. Box 5077 Person to Contact: <br /> Paul Supple <br /> FAX#: Customer Account Number with TPS: <br /> Buena Park, CA 90622 USA (925) 259-8872 1002532 <br /> Consultant's Name and Billing Address: Consultant's Phone#: <br /> Pinnacle Environmental Soluti.ont-j <br /> 2201 Broadway Person to Contact: <br /> Mark Christ:i.an <br /> Suite 101 <br /> FAX#: Customer Account Number with TPS: <br /> Oakland, CA .94612 LISA f§W 9d9=§ffq 4PINNAC <br /> Generation Site(Transport from): (tante&address) Site Phone#: BTEX <br /> Arco #'06080 :25 2 c-8-S Levels <br /> 85 Louise Ave. Person to Contact: Levels <br /> Paul Supple <br /> Z FAX#: AVG. <br /> c LBthrup, CA 00000 USA 0125 e _ ? Levels <br /> UDesignated Facility(Transport to): (name&address) Facility Phone#: Facility permit Numbers <br /> `o TPS TECHNOLOGIES INC. 510-235-6778 <br /> Person to Contact: <br /> lz 2CA Recycling Lane Debra Tuchaen <br /> FAX#: <br /> Richmond, CA 946011. USA 510-231-4154 <br /> Transporter Name and Mailing Address: Transporter's Phone#: Transporter's US EPA ID No.: <br /> Dillard Environmental. ( 925) 634-•6850 <br /> P. O. Box 579 Person to Contact: Transporter's DOT No.: <br /> Reagan Cortez <br /> FAY,# Cu A -ctltpt Number with'rps: <br /> Byron, CA 9 }5,14 USA (4251) Fato t r4 -0569 .s�f�►.��BV1 <br /> Description of Soil Moisture Content Contaminated by: Approx.Qty: Description of Delivery Gross Weight Tare Weight NetWeight <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other O 10-20% ❑ Diesel ❑ <br /> 20%-over❑ Other ❑ r <br /> Sand ❑ Organic❑ <br /> 0-10% ❑ Gas ❑ j <br /> .'1 ` 1 <br /> Clay ❑ Other u 10-20% ❑ Diesel U <br /> 20%-over❑ Other ❑ y <br /> List any exception to items listed above: <br /> i 1 <br /> Generator's and/or consultant's certification: I/We certify that the soil referenced herein is taken entirely from those soils deskqibedin the Soil D <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing has been added or done to such soil thr t-weuid-a fer it in <br /> any way. <br /> 'r Print or Type Name: Generator ❑ Consultant ❑ Signature and date: Month Day Year <br /> 4 vr. <br /> �tl4i� <br /> Transporter's certification: I/We acknowledge receipt of the soil described above and certifij that such soil is being delivered in exactly the sante <br /> } o condition as when received. I/We further certify that this soil is being directly transported front the Generation Site to the Designated Facility <br /> y without;off-loading,adding to,subtracting from or in any way delaying delivery to such site. <br /> Print or IJW <br /> /N/dame: / Signatuand date! Month Day Year <br /> /TATS <br /> rt• <br /> Discrepancies: j <br /> �. Z t <br /> _c Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: <br /> R •V <br /> Print or Type Name: Signature and date:' <br /> -7 <br /> cc / <br /> p�i�ese, rina7NOW I fr x kk� <br />