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TPST Soil Recyciers of CA <br /> 016 Non-Hazardous Soils <br /> Date of S1Spment Responsibsle for Payment- 'Transporter Trui*#: Facility#:' Given by TPST:. Loa <br /> #: <br /> .. /, . A07 . <br /> 66 <br /> Generator's I aati and'Btlhng Addyess: Gerieraticii Phone#: Generator's US EPAdD No. <br /> Bim <br /> 84 <br /> T S Q <br /> C+: �`6 8024.9 Perstin to Contact <br /> RA{'CHO.SANTAMARG.' ARITA, C-A 92M FAX# Customer Account Number with TPST: <br /> Consultant's Nasse and Billing Address: Consultant's Phone# <br /> Person to Contact <br /> VAX#: Customer Account Number with TPST: <br /> Generation Site(Transport fri (name S address} Site Phone M BTEX <br /> Levels <br /> 05460 <br /> Person to Contact: T1'1I <br /> •1$17WFR MOW'... levels <br /> w S OCKT ON, CA 95293 Ixax# AVG. <br /> Levels <br /> Designated Facility(Transport to): (uanre&address) Facility Phone#: Facility Permit Numbers <br /> i F'ST WIL kECYCLERS OF CA. FORNIA ( 'to <br /> Persocinn�ta Contact f <br /> 123281-IIBSCUS AVENUE 0MLENA JEFFREY <br /> o ADELAidTO.CA 92301 FAXI! <br /> (760)246--SW4 <br /> Transporter Name and Mailing Address: Transporter's Phone#: Transporter's US EPA 113 No: <br /> BE.L&ilRE ENVIR{3NMENTAL SERVICES, INC (94-2)404�2tTQ CA�:(3IjQ Id�'I7� <br /> FO'r1gi E CENTRE DR!VE Person to Contact Transporter's DOT No <br /> 25971FOOTHILL RANCH CA 192610E LARRY MOOT�iAFv7 �5 E <br /> ,II= I; 141062 FAX#: Customer Account Number with TPST: <br /> �949)4M52 10 1000193 <br /> Description of Soil Moisture Content Conteminaled by: Approx.Qty: Description of Delivery Gross Weight Tere Weight Net Weight <br /> sand 0 Organic U 0-109. D Gas ❑ <br /> 10-20% ❑ ❑ <br /> Clay 0 other 0 mer <br /> 2096-over' meT 0 fll ❑ [ 0 <br /> sand ❑ Organic❑ 0-10% ❑ Gas ❑ r(� <br /> 19-20% ❑ Diesel ❑ <br /> Clay ❑ Other Z120%-over❑ Other U <br /> I any exception to items listed above: Stale Ticktt# f-f <br /> p 1`- <br /> Generator's and/or consultant's cert fication: We certifty that the soil referenced herrin fsLaken entirely from those soils described in the Soil Data <br /> Sheet completed andcertifted by me/us for the Generation Site shown above and not ' g has b n added or done to such soil that would alter it in <br /> any way. <br /> Print ar Type Name: Generator ❑ Consultard O si$.atum <br /> Day Year <br /> �t <br /> Lang odhart of SESan behalf of gt�llillWor 1 ! <br /> Transporter's cert cation: We acknowledge receipt of the soil de a cert that such soil is being delivered in exactly the same <br /> ocondition as when received IlWe further certtly,that this soil is being directly transported from the Generation Site to the Designated Facility <br /> H without off-loading,adding to,subtracting from or in any way delaying delivery to such site. <br /> N Pratt or Type Name f - signature and date: Month <br /> "ay <br /> Year <br /> i <br /> On,t7iscrepandes: � - . <br /> -�5j, Recycling Facility certifies the receipt of the soil covered by this manifest except as no above: <br /> -Print or Type Naas Signature daM y f' <br /> P .M:lr t EY1.#. PRO tIAAtS <br /> y <br />