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x �rPST Sell Recyclers of U a T - 'atiyi..i.:�,' ii:Tii''M•3^!+tl ISM Ac,:�}pfa.j-� � y� �� r Nlf�l�r�'Lr.it:e>t Non-Hazardous Soils Date of Shipment: Responsible for Payment ' Transporter Track#: Facility 0: Given by TP6Tt� M _ Load# 3s 31 vG if y r Generator's Name and Billing Address: Generatar'sPhone# Generator's US EPA ID No , r-E_'VEE,INC. F 0. BOX 80741 Person to Contact: t^� RANCHO SANTA MARGARI—I A, CAk 92086 FAX#: Customer Account?Number with TPST: six oar r� Consultant's Name and Billing Addtcss: Consultant's Phone#: aka r.t Person to Contact: r.4' i FAX#: Customer Account Number with TPST: 5.1 +' Generation Site(Trampnrt from): (tame Fs address) Site Phone#-. ITTCX } • Ojiy;5 Levels r° 7-'EL EVEN 21766 K,13 Person to Contact: TPH a t„ 852 EAST YOSEN41TE levels '.' .WR., aerlAll i s=C . 1 rfuJL� FAX#: AVG. - � Levels xe? Designated Facility(Transport to): (nanrr Mnddress) Facility Phone(Boo)802-ewi #: Facility Permit Numbers F a•ti .o -TFST SOIL RECYCLERS OF CAUF{�I�iNHt A F Person to Contact: r';? �'. 12328 HiS3St;U5 AVENUt DELi.EN3 �Ei=FREY =rks t O ADELAH i 1 (4.is 92301 PAX#: "tri Transporter Name and Mailing 4ddress: Tran porter's Phare#: Transporter's US EPA ID No,: ; 4acv 52'vi. CAll Ctl0 i 9 S 9'I a „ Person to Contact: Transporter's •o.: y.• ��+f'I ?_ �W "Yj,.. Wt=ii,li-t=1:V C,AI'}',i�' tTl-1r1.r 'f rya t-00 i`HIL 3 r,+i't'JL:f"1 'A'02C1.0 ' PAX# Customer Account Number with TPST: t..; k( wa. Description of Soil Moisture Content Contaminated by: Approx.Qty: Description of Delivery Gross Weight TamWelght Net Weight •a t: ;Y 0-1096 J Gas ❑ t Sand U Organic ZI u ( ! '-r "} �iJ >> •.'��:` Cla ❑ 10-20 ❑ Diesel Q 7 �/ erf' U t✓ ,`h rc+' 7 u Other 20°k-over❑ Other ❑ 0-10% ❑ Gas ❑ r =Y V4 Sand U Organic U ' 10-20% Tl -wi -, ❑ Diesel ❑ a:S Gay a Other U 209n-over❑ Other ❑ ;..v ;tom list any exception to tterns listed above: �w Scale Ticket#``�i:�I�T"y{ • r✓ Generator's and/or consultant's certification: 1/We cert that the soil referenced herein is taken entire In Mi se soils described in the Soil Data • .L.. k•i W, aka Sheet completed and certified by me/us fortGeneration Site shown above and nothing has been acted or dome to such soil that would alter it in wl anyway Print or Type Name, Genaatar U Consultant U Signature and date �' ,r'� � Month l .; vara "ti -71 Nf a^ii 2r. b>whaif of r� atttl ;' 'ti. yh a. T'ransporter's certification: I/We acknowledge receipt of the soil described above and certify that sue soil is being delivered in exactly the same r; c condition as when received I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility yT'). 4 without off-loading,adding to,subtracting from or in any way delaying delivery to such site N t Si and date: .•f?/�-�; Month Day Year Print or Type h ame: ',7 tf signature f j,/1 '' :.� 06 t •M Discrepancies: 00 , .4a Recycling Factlity certifies the receipt of the soil covered by this manifest eelst as noted above: , Point or Type Name! 61gnand.date: D -.EFFRrY/J. fvROVAANSAL it r a TRANSPnRTFR COPY