Laserfiche WebLink
S Technologies Soil Recycli ,,� <br /> ' , aYL1 eSt �,,,�'Aanffest# y <br /> M Non-Hazardous Soils <br /> Res onsibie for Pa meal Transporter Truck# Facility* Given b TPS Load# <br /> Date ofShipment: p 06014 0 <br /> Gener4Mr LY7� <br /> Gtntrator's Phone# Gcncrator s US EPA ID No <br /> Gt-uerator s Name and 13illui�Addre�ti (209) 583-5545 <br /> ULTRAMAR, NC. <br /> 525 WEST THIRD STREET 1'LrsontoContact <br /> TERRANCE FOX <br /> FAX# Customer Account Numbcr with TPS <br /> USA <br /> HANFORD, CA 93230 (209) 583-3282 1002367 <br /> Consultant s Namc and Billing Address Comultant s Ph°ne# <br /> ' HORIZON ENVIRONMENTAL (9161 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Pt-, L�`A°kzta3ARKER F <br /> SUITE 7 <br /> FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 USA (916) 939-2172 4HORIZO <br /> Generation Site(Transport from) (name&address) Silt-Phone# 13nx <br /> lt-vels <br /> BEACON STATION #1-641 (209) 583-3247y <br /> 1210 EAST HAMMER LANE g Pt-rggnt°contact els <br /> 3ERRY UNRUH <br /> FAX <br /> STOCKT6N, CA 95210 USA t 209) 583-3282 AVG <br /> war Facility PermitNumbcrs <br /> DesrgnatedFacility(Tramportto) fname&addrec,) Facth�y510) 235-8778 y <br /> TPS TECHNOLOGIES INP. ,, <br /> 0 RECYCLING LANE P"�`�:°c ce/D. Murai3hima <br /> Ir <br /> 1 w <br /> C FAX# <br /> RICHMOND, CA 94801 USACD (510) 231-4154 <br /> Trans iter s Phone# Transporttr s LIS EPA ID No <br /> C7a �UTRELanTRUr(�3{ING $05) 399-0246 <br /> 6315 SNOW ROAD Person to Contact Transporter s DOT No <br /> HERMAN <br /> FAX# Custon4t "(timber with TPS <br /> BAKERSFIELD, CA 93308 <br /> Description of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight /Net Weight <br /> Sand ❑ Organic❑ 0-10% ❑ Gas, ❑El 10-20% Diesel ❑ <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ <br /> 0-10% ❑ Gas ❑ n <br /> Sand ❑ Organic❑ 10-20% ❑ Diesel ❑ d <br /> �r <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ <br /> Lut any exception to iters Listed above "� y <br /> Generatorts andlor consultant's certification Il We certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and cern ed by me/us for the Generation Site shown above and nothing has been added or done to such soil that would alter it in <br /> any way <br /> Punt or Type Name erator ❑ Consultant ❑ Signature and date <br /> Month Day Year <br /> MqAeow <br /> Trrter's dertification IlWe acknowledge receipt of the soil described above and certify at such soil is being delivered in exactly the same <br /> 'C condition as when received IIWe further certify that this soil is being directly transportad from the Generation Site to the Designated Facility <br /> Nwithout off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> C Pn or ype Name <br /> St�p�%� Month Day Y <br /> F+ to <br /> besclepancees � <br /> Recycling Facility certifies the receipt of the soil covered bylthis manifest except as noted above <br /> C1 St and date `• <br /> Prtpt or Type Name <br /> r. '-j <br /> Please Prins or type <br /> TPS INVOICING COPY - <br />