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"S Technologies Soil Recycling, Manifest k, Non-Hazardous Soils Manli@st#^ ' Date of Ship me Responsible for Payment: Transporter Truck#: Facility#: Given by TPS: Load 4 k;cnuratoCs flame and Billing Address: Cenenitor's Phone*: Generator's US EPA ID Noi.. S - ._ rant , ' v- - F !' I. , J Person to Contact. F:1X#: _ Customer ACCount Number%vitii TPS: r . Consultant's Name and Billing Address: Consultant's Phone#: i - :t N. c _ =.; ttt1-4•.1..3t 1.!k.�[ .� l-1 .,!i E_'?+ ;�'_ _. F.i- 1 f'•i r'*, q r;V Person t0 Contact: FAX#' Customer Account Number with TP5. Generation Site(Transport from): (name&address) Site Phone# BTEX . >•'r'c:l i.:t3" <ti t. 1 i. --1 r 3_•.i. ..i Levels - 3 I Person to Contact. TPH � .}:. �. �al;-._;r. i•.,._ _ :.- ?I:c!f] �.c1 r}�� Levels C i FAX#: AVG. A Levels UDesio ated Facility(Transport to): (name&address) Facility Phone#: Faui$h Permit Numbers Person to Contact; O •� FAX#: ..:1, t�_ir.:�! t.i`.� :}. 'r Transporter Name and Wailing Address: Transporter's Phone N: Y _ Transporter's lis EPA ID No.- ti Person 4o Contact- . Transpurter's DOT No. f� •Lt ;j.%? 7� __. % `t-7.-J- 'r,; �ti-jam_r. Customer Account Number with TPS: FAX(#, Description of Soil Moisture Content Contaminated by: Approx.aty: Description of Delivery Gross Weight Tare Weight Net Weight Sand ❑ Organic a 0_10% ❑ Gas Clay ❑ Other ❑ 10-20% O Diesel 20%-over❑ Other J Sand ❑ Organic] 0-10% ❑ Gas ❑ Clav 7 Other ❑ 10-20% ❑ Diesel ❑ 20%-over Q Other 7 - List any exception to items fisted above: i' Generator's and/or consultant's certification: I/We certify that the soil referenced herein is taken entirely from those soils described in the Soil Data 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 any way. or Type Nam Generator '❑ Consultant - Signature anddate: Month Day Year Transporter's certification: I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same condition as when received. I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility wwithout off-loading,adding to,subtracting from or in any way delaying delivery to,surh site. ,R C. Print or Typo Name: Si ature / Bn - Mon Dav Discrepancies: F. u tX Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: u Print ora Name: ZYP Signature and date: _ we t`_Plan or N, MW GE?JE?ATC',CONSULTANT'S COPY