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s' r TPS Technologies Soil Rec g Non-Hazardous Soils Date of Shipment: Responsible for Paymenh Transporter Truck It. Facility#: Given by TCS: Load# Generator. 04 00Ei41 Generator's Name and Billing Address: Generator's Phone#: Generator's US EPA ID No. Arca Products Co. P. O. Box 5077 Person to Contact: A Buena Park CA 90622 USA Customer Account Number with TPS: Consultant's Name and Billing Address: Consultant's Phone#: Pinnacle Environmental Solutions 2201 Broadway Person to Contact: Suite 101 FAX#: Chr:igti an(]t3lClSnd CA 94612 USA Account Number with TPS: LISA -r 00. Generation Site(Transport from): (name Er address) Site Phone#: BTEX Ai t�G #4�EaQ1Ei0 __ Levels r ofr onf�c. TPH 85 Louise AVe. Levels y —Aft: AVG. C - Levels UDesignated Facility(Transport to): (name&address) 14hon,ft. Facilitv Permit Numbers TPS TECHNOLOGIES INC. f C Person to Contact: 20 R ectyclil-Ig Lane 0 t`C FAX#: q) _ . 44144 4 Transporter Name and Mailing Address: Transporter's Phone.#: Transporter's US EPA ID No.: Dillard Environmental P- 0. B o X 579 Persson to(-ontact: Transporter's DOT No.: 4 Customer Account Number t,•ith TPS: H r ri G`A 94514 LISA ('.25) G34-0569 1002780 Description of Soil Moisture Content Contaminated by: A rox. y pp Qty: Description of Delivery Gross Weight Tare Weight Net Weight . Sand Cl Organic❑ 0-10% ❑ Gas ❑ ' Diesel ❑ Clay ❑ Other E) 10-20% ❑ 20%-over❑ Other ❑ it Sand ❑ Organic❑ Gas ❑ � 0-10% ❑ Clay ❑ Other ❑ 10-20% O Diesel ❑ 20%-over❑ Other ❑ List any exception to items listed above: Generator's and/or consultant's certification: 1/We certify that the soil referenced herein is taken entirely from those soils jescribed in the Soil Dat_1__ Sheet completed and certified by me/us for the Generation Site shown above and nothing has been added or done to such ibi,that-would'hVer it in any way. Print or Type Name: Generator ❑ Consultant ❑ Signature and date: Month Day Year Transporter's certification: 1/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same o condition as when received. 1/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility y without off-loading,adding to,subtracting-from or in any way delaying delivery to such site. C Print or Type Name: Signature and date: Month Day fear Discrepancies: w V tL , C Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: Print or Type Name: Signature and date:cc ( i > �F zya