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1 <br /> TPS Technologies Soil Recycling <br /> ` Manifest y "'a"`fost <br /> Non-Hazardous Saxes ' <br /> Date f 5hr ent Responsible for Paymgnt Transporter cic# �� Facility# Given by TPS Load# { <br /> Generator _ �p04 00014 5 <br /> Gcntrttor s N m.an Billing Addre45 tnerator a Phone# Generator s US EPA 1D No <br /> ULTRAMAR, INC. (209) 583-5545 <br /> 525 WEST THIRD STREET PtrsontoCon tatl 4 <br /> TERRANCE FOX <br /> FAX# Customer Account Number with TPS <br /> HANFORD, CA 93230 USA (209) 583-3282 1002367 <br /> Consult-int,Name ind Billing Address Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 50 B11 GOLDEN FOOTHILL PARKWAY Perbontucant <br /> GARY BARKER <br /> SUITE 7 FAX# Customer Account Numbcr with TPS <br /> EL DORADO HILLS, CA 95762 USA (916) 939-2172 4HORIZO <br /> Generation Sitc(Transport from) (nine&irddreb%) SAL Phone# BTEX <br /> Levels <br /> BEACON STATION #1-641 ptrsontoContact TP11 <br /> 1210 EAST HAMMER LANEJERRY UNRUH <br /> Levels <br /> .� FAX# AVG <br /> STOCKTON CA 95210 LISA - Levels <br /> VDesignated Facility(Transport to) (name U addrrsb) Facility Phone# Facility Permit Numbers <br /> c TPS TECHNOLOGIES INC. (510) 235-8778 <br /> Person to Contact <br /> 20 RECYCLING LANE Cheron Rice/Dor, urashima <br /> 0 <br /> FA X# <br /> RICHMOND CA 94801 USA (510) 231-4154 <br /> � T <br /> Transporter Namc and Mailing Address Transporter's Phone# Transportt <br /> lD No <br /> LUTREL TRUCKING (805) 399-0246Person to Contact Transporto <br /> 6315 SNOW ROAD HERMAN , <br /> p�X# Customer Account Number with TPS <br /> BAKERSFIELD, CA 93308 4LUTREL <br /> Description of Soil Moisture Content Contaminated by Approx city Description of Delivery Gross Weight Tare Weight Net Weight <br /> Sand ❑ diganic❑ <br /> 0-10% El Gas Ch <br /> 10-20% ❑ Diesel ❑ <br /> Clay ❑ Other ❑ 20%-over❑ Other ❑ <br /> El Organic O <br /> 0-10% ❑ Gas Q <br /> Sand <br /> Clay ❑ Other ❑ 10-20%-oO Diesel l3 <br /> 20% over Q Other Llv <br /> List any exception to items listed above <br /> Generator's andlor consultant's certification IlWe certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and certified 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 Moir <br /> Print or Type Name Generator ❑ Consultant ❑ Si re and date Month Day r <br /> Transporters certification I/We acknowledge receipt of the soil described above and cer ify that such soil is being delivered in exactly the same <br /> ocondition as when received IIWe further certify that this soil is being directly transported from the Generation St to the Designated Facility <br /> h without off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> RPent or T pe Name Signature and date �n� Day Year i <br /> IZI G� IL- n o n 11 g <br /> Discrepancies <br /> 1221 <br /> Recychng Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> qPrint or Type Name Si and date 't <br /> please print or type <br /> TPS INVOICING COPY <br />