Laserfiche WebLink
SOIL SAFE OF CA - TPST <br />Naz► -Hazardous Soils <br />Date of Shipment: Responsible for Payment: Transpurt True 8: ]Facility #: <br />/O /2.6 / (f <br />Generator's Name anB Address: <br />EXXON MOB �L C1: ORP, <br />ATM: EME� ADMINISTRATOR <br />2655 W i 90TH* ST. #1106 <br />TORRANCE, CA 90604 <br />Consultant's Name and Billing Address: <br />Cardno ERI - Petaluma <br />Geneiation Site (riansport from): (name & address) <br />EXXONMOBIL 09CAS <br />C 765 EAST ALPINE AVE, <br />:1 STOCKTON, CA <br />h <br />C <br />O <br />Cl Designated Facility (Transport to): (name & address) <br />SOIL SAFE <br />12328 HIBISCUS AVENUE <br />ADELANTO, CA 92301 <br />A07 <br />Genekator's Phone #; <br />310-212-2938 <br />Person to Contact: <br />PAX#: <br />Consultant's Phone #: <br />Person to Contact: <br />PAX#: <br />Site Phone #: <br />Person to Contact: <br />FAX#: ! — <br />Facility Phone #: <br />_t800)13132-11001 <br />Person to Contact: <br />DELLENA JEFFREY <br />FAX#: <br />as ad # <br />SWI <br />• I Customer Account Number <br />Customer Account Number <br />W. <br />246-130 <br />(7t3D 04 <br />2 <br />Transporter Name andMailingAddress: Transportex'sPhone #: <br />949-4130-5200 <br />CAR000183913 <br />BELSHIRE— - <br />PersontoCont <br />- <br />25971 TOME CENTRE DRIVE . LARRY MOOTHAF2T <br />460047 <br />FOOTHILL RANCH, CA 92610 _ <br />PAX#• <br />_^ <br />Customer Account Numbei <br />BESI:197836 <br />194G-460-6210 <br />Description of Soil Moisture Content Conlaminated by: Approxi Qty: Description of Delivery <br />(Gross Weight 111ore Weight Het Weight <br />0-10% ❑ Gas ❑ ✓ <br />El 0 IO -20% ❑ Diesel 13Lie,% t <br />2l`+� <br />49 "3�O --�' 7 <br />Clay Oter 411% - over ❑ Other ❑ <br />V <br />Sand ❑ Organic 0-10% ❑ Gas ' ❑ <br />10-20% ❑ Diesel ❑ <br />1 <br />/ <br />Clay ❑ Other ❑ <br />y 20% -over O I Other ❑ <br />List any exception to items listed above: Scale Ticket # <br />/ <br />2-2/61 <br />Generafo>'s and/or consultant's certification: I/We certify that the soil referenced herein is taken entirely from those soils descried in 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 <br />in any way.— <br />Print o ypeN.ame: Generator ❑ Consultant tuieanddat..:�l� <br />NVIN O - I; Month Day Year <br />I(I Cil 1e Cl1Mv� t%RI , -f <br />13 I i <br />Transporter's certification: We acknowledge receipt of the soil referenced above and certify that such soil is being delivered in exactly the same <br />fo the Designated Facility <br />condition as when received. 1jWejur0?95,qrtify that the soil is being directly transported fro�r..the-Generation-S' a <br />y <br />without off -toad d ' toyac rit: flay delaying delivery to such sif�---� - <br />C <br />Si ah� � rid ate; ` <br />Print or \lie._ ._ ! { QO.•.. t t �Av-1 <br />% MonthDay • Year <br />� {�t .. 1�0 �i <br />Discrepancies: <br />C- <br />z <br />Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: <br />VPrint or Type Name: Signature and date; <br />a� D, JEFFREY/J• PROVANSAJ. <br />1 TRANSPORTER <br />