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�PSTechnologjes Soil Recytli s= <br /> c-4 lanlfest# +�r <br /> manifest Soils u� <br /> r Date f Shipm Responsible for Payment Transporter Truck# Facility# Given by TPS Load# <br /> Generator �� �'� A04 00014j0p*71 <br /> Generator s US EPA ID No <br /> GlnLr itor 4 IVa e Ind Billing Addre�ti Generator s Phone# z 4 <br /> ULTRAMAR, INC. 1 (209) 583--5545 , <br /> 525 WEST THIRD STREET Pers°nt°Contact <br /> TERRANCE FOX ' <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 USA (209) 583.3282 1002367 <br /> Comulrint�Name and Billing Addm,s Consultant s Phone# <br /> HQRIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Person to Contact „" r <br /> GARY BARKER <br /> SUITE 7 FAX# Customer Account Number with TPS <br /> EL DORADO HILLS, CA 95762 USA (916) 939-2172 1 4HORIZO <br /> Generation Site(Transport from) (name&addrebs) Sitte,Phone# BTEX <br /> Levels a <br /> BEACON STATION #1-641 Person to Contact <br /> 1210 EAST HAMMER LANE ,TERRY UNRUH LQcels <br /> C FAX# AVG <br /> w� <br /> ` USA Levels <br /> STOCKYON, CA 95210 <br /> Facility Phonc.# — Facility Permit Numbers <br /> VDesignated Facility(Transport to} (cion:r£�addre a) y <br /> TPS TECHNOLOGIES INC. (510) 235-8778 <br /> Person to Contact <br /> Q 20 RECYCLING LANE C. Rice/D. Murash ma <br /> ro <br /> FAX# <br /> E0 RICHMOND, CA 94801 USA (510) 231-4154 <br /> Trans orter s US EPA ID No <br /> Transporter Name and Mailing Address Transporter s Phone# P + <br /> T LUTREL TRUCKING E805) 399-0246 <br /> 6315 SHOW ROAD Person to Contact Transporter s DOT No <br /> HERMAN <br /> FAX# Cu 4 L U T RE LNumber with TPS <br /> BAKERSFIELD, CA 93308 <br /> iption of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight Tare Weight Net Weight <br /> 4-100 ❑ Gas ❑ �I <br /> rSFand 'J Oigamc❑ 70-24% ❑ Diesel ❑ <br /> Other ❑ 20% over❑ Other ❑ <br /> Sand ❑ Organa❑ 10-20% <br /> 10% ❑ Gas ❑ <br /> I4-20% ❑ Diesel ❑ d" � <br /> Clay a Other a 20%-over❑ Other ❑ z <br /> List any exceptioit to items listed abovei v <br /> �. <br /> Generatorts and/or consultant's certification Il We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data <br /> Sheet completed and certified by me/us for the GenerationSite shown above and nothing has been added or done to such soil that would alter it in <br /> any way A E ��� u LT Ffi !� Ti IV G <br /> Print or Type Name Generator ❑ Consultant ❑ Signa <br /> Month Day Year � <br /> L Transporters certification I e acknowledge receipt of the soil described above and certify that such s being delivered in exactly the same <br /> a► <br /> ocondition as when received IjWe further certify that this soil is being directly transported from the eneration Site to the Designated Facility .` <br /> IF without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> I Si �_ Month Day Year ' <br /> Prm pe Name <br /> Mscrepancies I`y# <br />{ Recycling Facility cerfifies the receipt of the soil covered bythis manifest except as noted above s� <br /> 1 � Si d date <br /> PrinName TS <br /> Please print or type <br /> TPS INVOICING COPY <br />