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LIT ELTP-,> 1111;A4. <br />1 <br />- <br />r 1- �se <br />e-' r't. Q -',-rte ..:.cwt ���t_���i� �� r�� .S�.�a,.•ri...a <br />� r� st�nnwvy�s .� <br />Nor►=Harirdow <br />a r.c���..■.� <br />iL <br />Daft!' " :f`.' ffwEgitalbfe for Pant' 'il..fwcw <br />h, Facili*r ♦. <br />Grvm ba'. S:' ' .,` : "r' S��j oad • <br />£3R>ner<tOr. ,' A04 <br />00602 r ,;- 4 <br />.:, .. . <br />Gcrrera'oc's Nom' arid' 13iGbna Addrarsc <br />6vr'a k <br />Ce-nWator's US EPA ID No. <br />Arno P48ucte Co. <br />"t�•, ?. .. 99-8891 <br />P 0. a Box 5077 <br />Customer Accocuu Mumtrr with JFS: <br />Buena Park, CA 90622 /USA <br />C,w"Utt4At'1 Name and Billing Addrra <br />Cans <br />rants 11%mc tf: <br />Bogor <br />F#r1kc <br />I i>cantnct: <br />1225 Path Avenue <br />Robert Potter <br />FAY : <br />Cuetom.r Account Numbrr w[rh TTS: <br />Mountain Vier, CA 00000 "A <br />C n atlon Stre (nanaport trout) ivamw h addrrtal <br />Site <br />0- <br />BTEX <br />Levels <br />ARCO *04493 <br />Pe <br />m antacc: <br />TPH <br />205 North Center Strut <br />i> <br />PAI <br />AVG <br />Dmigtarcd Fadlity [Transport Ertl: Mamie b ad freed <br />fv <br />a <br />Fsdliry Permit Nurnt-" <br />'CPS T6CHkQf APT&$ <br />- <br />2W Reuyaling Larry <br />Persc <br />m CORMR <br />...... <br />FAX <br />Trwisportu None and Mailing Address: <br />Tr <br />rter's Mine k <br />Tmnsr-z�rter a US EPA ID No - <br />Di 1 ! atY d fE�ta f i o►rit�re7+rRgI <br />._ <br />P <br />lb Conte -*! <br />lransporter's DOT Na. <br />F, 0. Bax 379 <br />Customer Account N.wlher with TF-,: <br />Dew1plion of Soil <br />Molrture Conttirtt <br />Contaminated try: <br />Approx. Qty: <br />DeacHptlon of Delivery <br />Grose Weight Tare welghl <br />tit weight <br />54+d U thgacJc U <br />0- Ic" O <br />SO - 2CM Q <br />Can .0 <br />Diesel O <br />Qac o Oder r] <br />20% - oveF ❑ <br />Otho O <br />Sana U Qrpmc O <br />0-10% D <br />Gag Q <br />>� <br />Ly GCrMr V <br />10 - 20%0 <br />Dicrci to <br />r. <br />X". -ewer O <br />Other Q <br />La any ucepom w i�ema lSaled Ab - <br />0r <br />Ct rerator's andlm Ccrosullant's certiffcatio7l: 1/W[ certify that the soil refrrencx <br />h[reirr is tater rntirely from those Mils de, 7r.l in IIIc Soil l)at <br />Sheaf ctvmylefed and urtiffed try rnefus for the Generation Site shcrum aborre and <br />nothing leas been added or <br />dor to such soil that urruld alter it in <br />any. rwy. <br />Plin, m Thw Nam. Ger m" Q - Careuhwnr U SIQr-rwt• w d <br />dao: <br />M—di <br />Day <br />I tray <br />m <br />Tl•dnspor er 9 cerriftcetbn: I/We arimawledge receipt of the soli dmcrfbed a <br />and certif;r that sUCh self is being delivered in cractl y the sa>n< <br />comlitum as when rercftcd. 1/We further &Edify that this oofl is tiring #irectly <br />tram -ported from t1w Generahon <br />Site to the Dt-iQrtated Facility <br />without off !andira. 4dding to, subtTarNng from or in orry nary "mgrig if <br />ch sit <br />Rtxl!'rlf+ F�dlity"4rftefica tltc Tempi of tli, w"I f5dor1tf by th& rrui7f"V4.CtTt <br />Prl.1i <br />r� <br />r t <br />