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� H <br /> , S Technologies Soil Rerycli <br /> �» aiifest Non-Hazardous Soils 4, artifest* �+ <br /> 3w <br /> A Date of hipme b^ Responsxbie for Payment Transporter Truck# Facility# Given by TPS Load k <br /> Generator �C2 A14 00014 0 k <br /> t' <br /> Gem Mtor s NIme and Billing AddrEss Generator s Phone# Geircrator s US EPA ID No <br /> ULTRAMAR, INC. ( 209) 583-5545 <br /> 525 WEST THIRD STREET Person to Contact <br /> TERRANCE FOX <br /> HANFORD, CA 93230 USA FAX# CustomerAccount NumbervvithTPS <br /> ( 209) 583-3282 1002367 <br /> Comultant s Name and Billing Addnmss Consultant s Phone# <br /> HORIZON ENVIRONMENTAL (916 ) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY N-S"Gtofio 3ARKER <br /> SUITE 7 ' <br /> EL DORADO HILLS, GA 95762 USA FAX# Customer Account Nttmberwith TPS <br /> (9 16) 939-2172 4HORIZO <br /> Geile[ation Site(Transport from) tnamL&address) Site Phone# BTEX <br /> BEACON STATION *1-641 (209) 583-3247 1LVe1s <br /> 1210 EAST HAMMER L*NE Persan to Contact Tt H, a <br /> C JERRY UNRUH ievel5 <br /> FAX# AVG <br /> STOCkTON, CA 95210 USA (209) 583-3282 Levels <br /> < U Designated Facility(Transport to) (name&adds.,) Facility Phone# Facility Permit Numbers <br /> o TPS TECHNOLOGIES INC. <br /> (510) 235-8778 <br /> 20 RECYCLING LANE Person to Contact N <br /> C. Rice/D. Mura hima <br /> r� FA X# <br /> RICHMOND, CA 94801 USA ( 510) 231-4354 <br /> transporter Name and Mailing Address Transporter s Phone# Transporter s US EPA ID No <br /> LUTREL TRUCKING (805) 399-0246 <br /> 6315 SNOW ROAD Person to Contact Transporter s DOT No <br /> HERMAN <br /> BAKERSFIELD, CA 93308 FAX# Custom4rLACfiu gffnberwithTPS <br /> Description of Sod Moisture Content Contaminated by Approx Qty Description of Delivery Gross Weight 11 Tare Weight Net Weight <br /> Say ❑ Organic❑ 0-10% ❑ Gas ❑ ���/►� <br /> Cls ❑ Other ❑ 10-20% ❑ Diesel ❑ C•l! <br /> 20%-over L) Other Ll <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay Ll Other ❑ 10-20% ❑ Diesel ❑ <br /> 20%-over❑ Other ❑ <br /> List any exception to items luted above <br /> 1 i <br /> Generator's and/or consultant's certification I/We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data <br /> Sheet completed and certifiel by mews for theener i op Site shown above and nothing has been added or done to such soil that would alter it in <br /> anyway <br /> Pont ar Name for ❑ Consultant ❑ Si a ]e}z; <br /> r Transporter's Irtification IlWe acknowledge receipt of fate soil described above apf certify that such soil is being delivered in 7exactly the same <br /> C condition as when received IlWe further certify that this soil is being directly transported from the Generation Si fo rrDesignated c*_ <br /> hwithout off-loading,adding to,subtracting from or in any way delaying delivery to such site <br /> LLC Pn t Name Signa d d 4. <br /> 'Discrepancies v <br /> Recychng Facility certifies the receipt of the sod covered by this manifest except as no <br /> YPe NamrSigna date <br /> UCIt 4 i { <br /> Please print or type <br /> TPS INVOICING COPY <br />