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,; —131S Technologies Soil Recycling Manif est Non-Hazardous Soils Dale of Shipment: Responsible for. Payment Transporter Truck#: Facility#: Given by TPS: Load= Gcnorator's Nems and Blllin,, Address: Generator's Phone ft: Generator's L'S EPA ID No. c dr _. Person to Contact: FAX 4: Customer.account Number with TPS Consultant's Name and Billing Address: Consultant's Phone#: •',? ! 1 'c- -' - r--r t �. :i v Person to Contact: Y'-A - ., FAX#' Customer Account dumber with TPS: Generation Site(Transport from): (name&address) Site Phone#: gTEX 1-)%••3;_v:! 1 _i t ..'ti[t i. Levels .t,zt I 1'. t t, j;t I `.l� Person to Contact: TPH .r �. Levels �C _ FAX#: � AVG. A -i r:Y l_' ':1 Levels U Designated Facility(Trimport to): (name Pr address) Facility Phone#: Facility Permit Numbers_ , O1. t`. Ti=.'..tit•�i_I(, :!-l . e� Iti'_,. +:1 -.-.-) � .. Person to Contact: ro ?. M+ 1, >r " 0 _ FAX#: -�i;,I -A I+ CA -1}-iif.)1. _IL:.I ... L - `Yl�t''t Transporter``ame and`)ailing Address: Tran5orter's Phone#: Transporter's US EPA 1D No.: 7 el _ Person to Contact Transporter's DOT No.: Customer Account Number with TPS: -i Description of Soil Moisture Content Contaminated by: Approx.Qty: Description of Delivery Gress Weight Tare Weight Met Welgh Sand 7 Organic-1 0-10% ❑ Gas 7 Clay ] Other ] 10-20% ❑ Diesel 7 20%-over❑ Other ❑ Sand >I Organic D 0-101% ❑ Gas 7 Clay 7 Other Z1 10-20% ❑ Diesel 20%-over❑ j Other Z) List any exception to items listed above: ' 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. Print r Type Nam -- Generator Consultant ❑ Si a and da ZZ gnMonth Day ?: Transporter's certification: I/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same c condition as when received, I/We further certify that this soil is being directly transported from the Generation Site to the Designated Facility without off-loading,adding to,subtracting from or in any way delaying delivery to such site. A Print or T Name: �. _ f Signature and da 1r19 y tear Discrepancies: • -�_._�._ - - Z ivy dl Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: ''�-- `�' •' U Print or T Name: Type Signature and date: r �IeraN p d -i' G_-\1_:.R,_T02/CONSI;L7,ANT'S COPY