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a <br /> _ PS Technologies Soil RecycliAa"ifest# 4 , .f <br /> Manifest Non-Hazardous Soils r 7 <br /> Transporter Truck# Facility# Given by TPS Load# <br /> pate Ship Responsible for Payment p A04 00014 4 <br /> Gs�nerstor �i <br /> Generator s Phone# GEnLfatnr s US EPA ID No r <br /> Generator amc and 13rilint Addresy (209) 583-5545 <br /> ULTRAMAR, INC. <br /> 525 WEST THIRD STREET PUr on to Contact <br /> TERRANCE FOX <br /> FAX# Customer Account Number with TPS <br /> ,HANFORD, CA 93230 USA (209) 583-3282 1002367 t <br /> r <br /> Cumultant s Name.and Billing Address Consultant e Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Person toContact <br /> GARY BARKER 41111 <br /> SUITE 7 FAX# Customer Account Numbcr with TPS <br /> EL DORADO HILLS, CA 95762 USA (916) 939-2172 4HORIZO <br /> Site Phone# STEX <br /> Gcncratlon Sik(Transport from) (name&address) LEVe15 r• <br /> BEACON STATION #1-641 (209) 583-3247 <br /> Penson to Contact 'H <br /> 1210 EAST HAMMER LAWS JERRY UNRUH wets <br /> .fid, t t FAX# AVG }ag <br /> Levels <br /> c STOCKTON, CA 95210 USA (209) 583-3282 <br /> Facility Phone# Facility Permit Numbers <br /> U Designatc�l Facility{Transport to) G:nate£�addrt�s) (510) 235-8778 t <br /> TPS TECHNOLOGIES INC. PcrsgntoContact ` <br /> c 20 RECYCLING LANE C. Rice1D. Nursed ms <br /> m <br /> FAX# 4 <br /> RICHMOND, CA 94801 <br /> USA (510) 231-4154 <br /> Transportcr s Phone# Transporter s US EPA ID No <br /> Transportcr Name and Mailing Address (SOr�. ) 399.0246 <br /> LUTREL TRUCKING <br /> 6315 SNOW ROAD Pcrson to Contact Transporter 5 DoT rin <br /> HERMAN <br /> FAX# Custgtrtpr� pt Number with TPS <br /> BAKERSFIELD, CA 93308 9LU L <br /> Description of Sad Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> 0 10% ❑ Gas ❑ J�� <br /> Sand ❑ Organic❑ 10-20% ❑ Diesel Q t <br /> Clay ❑ Other ❑ 20�%-over❑ Other ❑ <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ h f <br /> 10-20% ❑ Diesel Q <br /> Clay ❑ Other ❑ 20%-over❑ Other U � <br /> t Y <br /> fast any exception to items hs ! <br /> Generator's and�or consultant's certification IlWe certify chat the soil referenced herein is taken entirely from(hose soils described in the Sol!Data <br /> it <br /> Sheet coin feted and certified by mews for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way eN V �N <br /> Month Day Year ,tF <br /> Print or Type Name Generator ❑ Consultant ❑ Sr at and date <br /> 4. <br /> ai Transporter's certification IJWe acknowledge receipt of the soil described above and certify that such sal is being delivered in exactly the same i <br /> t condition as when received IlWe further certify 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 /> Month y Year 't <br /> 'M Print or Type NamI !lab <br /> e t Sito and date ri�1 <br /> = il A.9 &AK ` <br /> Chscrepancies r <br /> V <br /> C Recycling Facility certifies the receipt of the soil covered btthis manifest except as noted above <br /> Vf„ Print or Type Name Signature and date <br /> (CCCC�//// c • <br /> • r <br /> cr� L too, <br /> r� <br /> please print or type f <br /> TPS INVOICING COPY <br />