Laserfiche WebLink
TPS Technologies Soil Recycling <br /> Non-Hazardous Sods <br /> Date of Shipment Responsible for Payment Transpor*r Truck# Facility# Given by TPS Load# ' <br /> f 211 13 B1Ef sF iRE r f r. AO-71 <br /> Generator s Name and Billing AddiESs Gener3lor s Phone# Gtneratoi s US EPA ID No tit s <br /> d <br /> 7-11 CA�,rpr ration Person to Contact f <br /> 14220 SW GRFENBURG SUITE 470 <br /> PORTLAND, OR 97223 FAX# Customer Account Number%,th TPS <br /> Consultant s Name and Billing AddiLss Consultant s Phone# <br /> Person to Contact <br /> FAX# CrestOmtr ACCOIent Number with Tl'S <br /> Geif i al1rt from) Olame&address) Site Phone# BTEX <br /> Levels <br /> 2725 COM" Club FAvd. <br /> Staiktn, ca Person to Contact TPH <br /> � [xveis <br /> � FAX# AVG <br /> Levels <br /> Dem mattd Facility(Transport to) (nanii &address) Ro ftVB001 <br /> Facility Penmt Numbers <br /> `o TPS TECHNOLOGIES, INC. <br /> � 12328 HT$ISCllS AVENUEPerson to Contact <br /> a` ADELANTO, CA 92301 <br /> 'Mb-246--8004 <br /> to <br /> Transporter Name and Mailing Addressgr � i Trans�r� �1 <br /> 25422 TRABUCO ROAM *105-269 `i!AKAfftbTHART Trans"Wff No <br /> ., <br /> LAKE FOREST, CA 92630 <br /> BES1#66122.42 450-1177 Custowdng§Nurnber with T$S <br /> Description of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> A Sand Q Organic 0 0-10% ❑ Gas ❑ <br /> Clay U Other ❑ 10- C3-o Q Diesel <br /> 20%-over❑ Other L] <br /> Sand ❑ Organic❑ 0-101/6 ❑ Gas ❑ <br /> Clay ❑ Other O 10 20% ❑ Diesel ❑ !'1 r <br /> Lest any exception to items fisted above 20%-over❑ Other ❑ <br /> Generator's and/or consultant's cert ficatlon I/We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing been added or done to such soil that would alter it in <br /> any way <br /> P t r aIWOOTHART M`ft Or Gen raWr) Q Signature and d Month }ay Year <br /> Tra fir's cert ficaf'on I e acknowledge receipt of the soil described and cert that such soil is ing delivered in exactL <br /> he same <br /> o Gond ion when received /We further cert fy that this soil is being directly nspor d from the tion Site to the Designated Facility <br /> runt ut -laadtn ,a ding o,subtracting from or in any way delaying delivery o suc site�.�� <br /> P a a Signature da Month Bay Year <br /> es <br /> ti { <br /> V <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> Print or Type Name Signatuee and dater r— <br /> TRANSPORTER COPY <br />