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TPS Technologies Soil Recycling <br /> Non-Hazardous Soils <br /> Date of Shipt Responsible for Payment TOL-Porter Truck Ih� Facility# G rven by TFS Load# <br /> fi <br /> BE <br /> Generator Name an frilling Address den ra or s Phone# Generator s US EPA[D No <br /> 9 ;;��{{,,11 LL INC. Person to C antact <br /> 7—EI.EWN, NC <br /> P. 0. BOX 80741 FAX# Customer Account Number with TPS <br /> RANCHO SANTA MARGMITA. CA 92688 <br /> Consultant s Dame and BiIIing Address Consultants Phone# <br /> Person 1.Contact <br /> FAX# Customer Account Number with ITS, <br /> Generation Site(Transport from) oxime&address) Site Phone# BTEX <br /> Levels <br /> 7-ELEWN,*20632 <br /> rPH <br /> 4924 Dl V� i m Person to C ontact Levels <br /> W STOCKTTON, CA 95207 ---- - Lev <br /> .. FAX# AVG <br /> Levels <br /> y <br /> C <br /> VDesrgnatcd Facility(Transport to) (nanie£s address) Facility Phone# Facility Perrrut Numbers <br /> 800-862-8001 <br /> TPS TECH LO(3IES, 'ltiC r Person to Contact <br /> 12328 NIMSCU9AVENUE DEILLENAIEFFREY <br /> ADELANTO, CA 92301 FAX# <br /> 760-246-9004 <br /> Transporter Name and M ulmg Address Transporter s Phone# Transporter s US EPA ID No <br /> 949-460-5200 CAD983 Eft <br /> f.7.E.&PL, Person to Contact Transporter 5IX)l No <br /> 2597I TOWNE CENTRE DRIVE L <br /> RY MOOTHART 4x0641 <br /> LAKE FOREST, CA 92 610 o �t �q��,t+��7iry //yy y ry gCustomerrAcccount Number with TPS <br /> B S1* 10990.02 '"F[:!'4)-52 0 9i,r <br /> Description of Soli Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tart:Weight Net Weight <br /> Sand C1 Organic O 0-UP/. ❑ Gas ❑ <br /> Clay U Other O <br /> 10-20% ❑ Diesel ❑ t )Z 0 �L(Z /[F„� <br /> 20%-over ❑ Other ❑ F 1 J <br /> Sand U Organic U <br /> 0-10% ❑ Gas ❑ a f1 <br /> 10-20% ❑ Diesel ❑ <br /> Clay Cl Other ❑ 20%-over❑ Other ❑ <br /> List any exception to ttems listed above 1 <br /> i <br /> Generator's andlar consultant s certification I/We cert that the soil referenced herein is taken entirely from those soils described in the S Data <br /> Sheet completind cert fled by me/us for the Generation Site shown above and nothing has been added or done such soil that would al it in <br /> any way <br /> Pont or i)5T Npu,e Generator U Consultant U Signature and date Month Day Year <br /> LARRY.MO �'i�iART 8M for GeneratDr <br /> Transporter's certification IM c owl ge receipt of the soil described above and cer s - delivered exactly the same <br /> ocondition as when received e fu h rtify that this soil is being directly transported fr nerah n a to the ignated Facility <br /> C without off-loading,adding t subtr tin rom or rn any way delayin u,sryto-s sit r” <br /> Pnn 1t ,,,� ¢ r' 51 and ate at � th i <br /> i <br /> Discrepa 1 <br /> C Recycli Fa_ tty certifies the receipt of the soil covered by this manifest except as noted above <br /> Print or Type Name Signatu and date <br /> C5— <br /> D. JEFFREY <br /> 7 PROVANSAL <br /> �l � <br />