Laserfiche WebLink
SOW <br />Date of Shipment ; Responsible for PaymenN <br />Generator's Name and billing Address: <br />S <br />EXXONM08fL Oil. CORP. <br />ATM: EMES'ADMINISTRATOR <br />2655 W. MOTH ST, #1108 <br />TORRANCE, CA 9ORM <br />Consultanfa Name and B•llfngAddress: <br />Cardno ERI - Petaluma <br />Generation Site (Pransport from): (name & address) <br />EXXONMOBIL WAS <br />1: 7f3 EAST ALPINE AVE, <br />L STOCKTON, CA <br />c ' <br />FE "OF CA - TPST <br />i -Hazardous Soils <br />Transpport J' ":7 <br />8: 1Pacility <br />`I I -7 r A07 <br />Generator's Phone #: <br />310-212-2938 <br />Person to Contact: <br />PAX#: <br />Consultant's Phone #: <br />Person to Contact: <br />PAX#: <br />rite Phone #: <br />erson to Contact: <br />PAX#: <br />U DealgnatedFacility (rranspoctto):(name &address) <br />° <br />a SOIL SAFE <br />12328 HIBISCUS AVENUE <br />ADELANTO, OA 92301 <br />Padlity Phone M 1 <br />(t3a0) 862-8001 <br />Person to Contact: <br />OELLENAJEFFREY <br />PAX#: <br />w <br />760 240-8004 <br />Transporter Name and Mailing Address: <br />Transporter's Phone ii: <br />94"60-6206. <br />BELSHI RE <br />15971 TOWNE CENTRE DRIVE <br />Person to Contact <br />LARRY MOOTHART <br />FOOTHILL RANCH, CA 92610 <br />PAX#: <br />BESI; 197836 <br />94t3 -4M6210 <br />Approval Number. Load # <br />Customer Account Number <br />ti <br />f� <br />Customer Account Number <br />i. <br />t <br />CAR000183913 <br />460647 <br />Customer AccountNumber <br />0escriptfon of Soll Moisture Content Contaminated by: Approx. Qty, description of Delivery Bross Weight Tare Weight Net Weight <br />Sand ❑ Organic ❑ 0-10% ❑ Gas ❑ <br />Clay❑ Other ❑ 20% <br />0 - 11 Diesel ❑ <br />2 <br />0% - over ❑ Other ❑ + v <br />Sand Ll Organic 0-10%. ❑ Gas ❑ <br />Clay❑ Other ❑ 10-20% ❑ Diesel ❑ <br />2046 - over ❑ Other ❑ <br />r <br />Scale Ticket #Listanptiontmsda:�gU, <br />cl 41 Ll <br />Generator's and/or consultant's certification: We certify that the soil referenced herein is taken entirely from those soils descried in the Soil Data <br />Sheet completed and certified by mews 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 />Rd* or Type Name: Generator E3Consultant 5ignature and date: ��� �p It (ti(( A I (C'6i4onfn Tray rear <br />% t In , f �1 <br />I- Transporter's eertiftcatio : W- a acknowledge receipt of the soil refereiice above and certifij that such soil is being delivered in exactlt,�''the sante <br />c condition as when r?c iived. IrWe further certify that the soil is being directl -Ir ns o d from the Generation Site to the Designated Facility <br />91 without off-loading, ddlh to, subtracting front or ht anyway delaying deli ry i U tte. _ <br />Print or Type Name: :Signator ! Month Da Year <br />Discrepandes: <br />cj q(/js <br />•S Recycling Facility cert f es the receipt of the soil covered by this manif t except as noted above: <br />RPrint or Type Name: S3 g and date: <br />D..EFFREYIJ. PROVAN5AL I�t � lkvA [0 <br />TRANSPORTER <br />