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r <br /> TPS Technologies Soil Wecycling <br /> Non-Hazardous Soils <br /> 7�1( <br /> hipment: rHIRE <br /> le for Payment 7karispa r Truck it Facility p even by lr-sc Load <br /> 114 7; - 1�/5 <br />' s Name and Billing Address Generator s Phone* Generator s US EPA ID No <br /> EVEN INC. Person to Contact- <br /> 1220 SW f-sREEMBURG aiUrM 470 <br /> PORTLAND, OR 57233 FAXIk Customer Account Number with TPS <br /> Consultant s Name and Billing Address Consultant s Phone# <br />' Person to Contact <br /> FAX#t Customer Account Number with TPS <br />' Gepet 3 a�i [liar s��} (name&ratdress) <br /> Site Phone k BTEX <br /> Levels 4 <br /> 2360. rant Line Rd. Person to Contact TTMCYe <br /> Is <br /> � <br /> FAM AVG <br /> CLevels <br />' U d]iestgrtated Facility(Tran9port to) (rianie&address) i i � Facility Permit Numbers <br /> c TPS TECHNOLOGIE% INC. <br /> 1.2329 HIBISCUS AVENUE DUAWi'EFFREY <br />' o ADE-LANTO, CA 92301 <br /> � �-2�-13tA04 <br /> Transporter Name and Mailing AddressTran� S � <br /> �p <br /> 25971 TC) tlhiir CENTRE DRIVE ��C1p}�?THART <br /> Trans TNo <br /> LAKE FOREST, CA 92610 �F <br />' V BEM#10=111.02 <br /> '&4W-3210 Custgr��cAssoyaltNumberwuhTPS <br /> Description of Sal Moisture Content Contaminated by AppraL Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand O Organic❑ 0-10% © Gas ❑ f �� ��-9-7-0 <br /> Ciay ❑ Other O 10-20% ❑ Diesel Cl <br /> 209.-over❑ Other ❑ <br /> Sand 0 Organic❑ 0-1096 ❑ Gas ❑ <br /> Clay o Other u <br /> 10-20% O Diesel ❑ <br /> 20% over❑ Other Ci <br /> List any n ceptwn to ite .lated above- ry <br /> Generator's and/or consultant's certification I/We certify that the soil referenced therein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and certified by meM for the Generation Site shown above and nothing has been added ar done to such soil that would alter it in <br /> any <br /> t pway <br /> � t <br /> 'LL"UKiCT QTH 18&nr T (OM Mr (3en O Signature and date <br /> L Transporter's certfication I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> condition as when received I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> without off-loading, ddinyg�to,subtracting ppm or in aniy way delaying delivety to site <br /> Print amt *y i t> ct 5lgneture and d d+ App Year <br /> ev <br /> Discntp Nim <br /> Fac#I22Z <br /> ID#00 <br /> j <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above r <br /> Printcr Type Name: Signatum and date <br /> D. JEFFREY /J. PROVANSAL <br /> TRANSPORTER COPY <br /> t <br />