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^vTTii�E <br />;i+ .± 1Y.}•.. aE,s (--s�;i� '.b.�:t'.¢ l,t i' Awa <br />a } <br />: <br />PS technologies So Reqyc i <br />■ <br />F N6i> Hazardous.: <br />oils <br />')I]Rfjy O=t}a Me for ayyyment iYutspo bec <br /># Facyil�iyty ��i <br />i" 5 - <br />'RffJ4 <br />1. <br />yy <br />rlfl�0� <br />Genera s <br />Gew <br />ator's Phone M <br />Gener'ator's US EPAIDNo <br />Ar(�o Frot+tt�- C©. _ <br />E 9 <br />5 l 299-89'91 <br />qq a�gs�e <br />-► Yi _�; ��x ��7sI! /., - `" <br />Pero to Contact <br />- <br />__PAt1 <br />Supple- <br />- <br />FAXq <br />Customer Account Number with tPS <br />Rues Fark,A 9022 USA <br />M5) 5 f 299-88720033 <br />Consultant's Name"snd Billing Addis: <br />Com <br />dtant's Phone #: . <br />tae ©r <br />(6 <br />0) 691-0137 <br />Pezw <br />i to Contact: <br />1225: Pear Avenue <br />Rn <br />ert Patter <br />MoOntei.n ': View,, CA 00000 USA <br />FAX#: <br />Customer Aeeaunt,Number with.TPS: <br />(fi <br />0) 691-9837 <br />4SECt3R9 <br />Generation Site (Trartsptirt from): "(name &address)- <br />Site P one #: <br />BTFX <br />ARCQ'. 864493. _. <br />-AARIA <br />Levels <br />Peso to Contact: <br />TPH <br />Lev is <br />' <br />-205 NorthCenter Street <br />. <br />FARC <br />AVG. <br />Cji <br />USA <br />Levels <br />U <br />Designated Facility (Transport to): (rarme& address) <br />Facilit <br />r Phone # <br />Facility Peanut Numbers <br />TPSTECH HQ�OGIES INC. <br />51-235-8778 <br />�Perso <br />Debre <br />to Contact: <br />Tuaheen <br />2 Reaycfn`.Laine <br />O <br />'. <br />FAX#: <br />�iCh�aand <br />A, 94801 USA <br />510-231-4154 <br />Tr ♦nsportei Name and Maiiirig-Address: <br />Trans <br />rter's Phone #: <br />Transporter's US EPA ID No.: <br />Df 1 i aid ' Enr ronamentail <br />(9 <br />5) 534--6850 <br />`` <br />Persor <br />to Contact: <br />Transporter's DOT No.: <br />'P". Qr .5OX 579 <br />Re <br />an Cortez <br />ayrr�ns - 4514 USA <br />FAX#: <br />(SM) 634-0569 <br />Customer Account Number with TPS, <br />' 1002780 <br />Description oF,So r, ;,: <br />Moisture. Content <br />Contaminated by: <br />Approx. Qty: <br />Description of Delivery <br />Gross Weight Tare Weight <br />Net Weigh <br />clna ❑ `' o a <br />�- Clay ❑ `: -Other : ❑ <br />1 <br />o-10%.. C1 <br />10-20% 20-20 % ❑ <br />201/6 -over ❑ <br />Gas ❑ <br />Diesel ❑ - <br />Other ❑ <br />., <br />Sand ❑ organic Q <br />0-.10% ❑ <br />10 20% ❑ <br />Gas ❑ <br />Diesel ❑ <br />Cray a Other. ❑ <br />20% - over ❑ <br />Other ❑ <br />.any acePUM to iteuts bated above: <br />aO <br />Generator's and/or consultant's cgrti cation: I/We certify that the soil referenced herein is taken entirely from those soilk&cribed in the Soil Dad <br />Sheet completed and certified by me/us for the Generation Site shown above and othing has been added or done to such soil that would alter it in <br />any way. <br />Print or Type Name: Generator ❑ Constdtant ❑ <br />Sigtiature and <br />date: <br />Month Day Year <br />Transporter's certification: I/We acknowledge receipt of the soil described above and certify that `such soil is being delivered in exactly the same <br />'ng <br />CL <br />condition as when received. We further certify that this soil is b irectly <br />without off-loading, <br />sported from the neration <br />Site to the Designated Facility <br />adding'to, subtracting from or in any way dela g J' <br />such site. <br />Prylt or Type N-7--- tine <br />' � ✓ f lam_. .�, <br />d date: <br />Month Da Y <br />i <br />Mcrepanines: <br />y <br />V <br />Recycling Facility certifies the receipt of the soil covered by this manifest except as note above; <br />Print or Type Name: Suture and ate: <br />- r <br />TRANSP45RTFRS [A Y <br />