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PS Technologies Soil Recycli � 1Vianifes #i � <br /> Maifest 71- <br /> n__ Non-Hazardous SailsLoad k <br /> Responsible for Payment Transporter Truk# Facility# Given by TPS 0 3 <br /> Date of Shrpme t P A04 00014 <br /> S �� Generator <br /> Gen rater 5 Phone# Generator s US EPA IL)No <br /> Guu.rator s Ntint and BillingAddn�4 <br /> ULTRAMAR, INC. (20G) 583-5545 <br /> Person to Contact ' <br /> 525 WEST THIRD STREET TERRANCE FOX <br /> FAX# Customer Account Number w ith TPS <br /> HANFORD, CA 93230 USA (209) 583-3282 1002367 <br /> y Consultant s Phonc# <br /> Consultant s Namc. ind Billing Address (916) 939-2170 t <br /> HORIZON ENVIRONMENTAL <br /> Person to Contact <br /> 5011 GOLDEN FOOTHILL PARKWAY GARY BARKER ` <br /> SUITE 7 FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 USA (916) 939--2172 4HORIZO <br /> Site Phonc.# BTEX <br /> Generation Site(Transport from) (natne &addrebs) Levels <br /> BEACON STATION #1-641 <br /> Person to Contact <br /> 1210 EAST HAMMER LADE ,TERRY UNRUH I eveks <br /> C AVG <br /> S FAX# <br /> � Levels <br /> as STOCKTON, CA 95210 USA - <br /> >` Faciht Phone# Facility Permit Numbers <br /> VDesignated Facility(Transport to) (name&addmi a ) (51 0) 235"8778 <br /> o TPS TECHNOLOGIES INC. FFAX# <br /> to Contact <br /> F, 20 RECYCLING LANE RiCe/D. Murash me , <br /> ^ RICHMOND, CA 94801 USA 0) 231-4154 <br /> d1 7Tra� rter's Phonc.# Transporter s LIS EP7with <br /> �_ zlransportcs Name and Mailing Address 399-0246LUTREL TRUCKING Tracts orter s DoT t�Contact p6315 SNOW ROAD MAN <br /> FAX# Cus�to�npT�c�o�r�t <br /> BAKERSFIELD, CA 93308 L.13 L <br /> Description of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Gross nWeight <br /> 0 10% ❑ Gas ❑ L-[J <br /> Sand ❑ Organic❑ 10-20% ❑ Diesel ❑ <br /> Clay ❑ Other ❑ 20%-over❑ Other L❑ <br /> 0 10% ❑ Gas ❑ aSand ❑ organic❑ 10-20%a ❑ Diesel ❑Clay ❑ other ❑ 20%-over❑ Other ❑ <br /> 1List any exception to nems listed above, oil <br /> Generator's andlor consultant's certification TlWe certify that the soil referenced herein[s taken ent:rely from those suclieata � <br /> Sheet completed and certified b(�,mews for the Gleneratione Site shown above and nothing has been added or done to such soil that would alter it to .F <br /> ami way a ,ei + T�v/ Ok -V_1, w�t J Month flay Year <br /> Pent or Type Name <br /> Generator ❑ Consultant ❑ sigoatu to e <br /> Transporter's certification Il We acknowledge receipt of the soil descr[b a and cert t such soil [s being delivered [n exactly the same <br /> ocondition as when received i1We further certify that this soil is being directly transported from the Generation Site to the Designated Facility <br /> f without off-loading,adding to,subtracting from or in any way delaying delivery to such site Month nay Year ., <br /> g d date <br /> T Name e, <br /> E.. r <br /> `3 <br /> Discrepancies ' <br /> V <br /> Lty certifies the receipt of the soil covered btfth[s manifest except as entad above <br /> or <br /> e Signature and da <br /> k 7/2 � <br /> �,r3 `L t c_e__ � <br /> e <br /> Please print or type <br /> TPS INVOICING COPY <br />