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:C Recycling Facility certifies the receipt of the soil covered by this manifest except as noted 4 bone: Print arType Name: and da v. z/ TQenrcanoTGioc 20 Rersycling Lente Person to Contact: Dib a Tuch®en FAX#: m. R� hmnd CA-94801 .� Transporter Name and Matting Addressr Transpo 's Phone #: Transporter s.US'EPA ID No:: billlar..d En irc nmental Person to Contact: Transporter's DOT No.: Paido7C .1%9 pyran,A 94514 USA -an Cart.eljl FAX#: (92P) 634w069 Customer Account N_iumber with TPS: . Zescrlption of Soil Moisture Content Contaminated by:. Approxi Qty: Description of Delivery Gross Wefgfit. Tare Weight Net Weight saw 'n orgrinlc a no% . o Gas (3 Orli 10 r 20% - b Diesel a 20% over 0 Other 0 .'o(Xprdcd 0_10% _ . 0 Gas O 10 - 20%. .0 Diesel 0 .Clay . ¢ otlkr a .. . 2096 - over 0. Other O tty.exaceptiori to hears listed above 9. Generator's and/or consultant's cert tion: I/We c"fy that the sock referenced hemn is taken entirely jivm those Sheet completed and certified by me/us for the Generation Site shm m above and n'thing has been added or done to such soil that would alter it in any way. .. Pune or Type Name: _ 'Ga eraror - D Consultant_ a Signature and _ - - Month - Day Year m T'ransporter's certification: I/We acknowledge receipt of the soil descrjW above a certify that such soil is being delivered in exactly the same o . condition as when received. I/We further certify that this soil is bein directly t nsported from the Generation Site to the Designated Facility e to C without off-loading, adding to; subtracting from or in any way de ivery to such site. Print or : :C Recycling Facility certifies the receipt of the soil covered by this manifest except as noted 4 bone: Print arType Name: and da v. z/ TQenrcanoTGioc