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p y - r _ 1 .;®IL SAFE OF eA 77 PST <br /> 115"'i.fi •` , 41y�,1j1If-e '4TH , rt rz�;�.*; Non-Hazardous Soils <br /> A <br /> Date of Shipment: Responsible for Payment: TransitTm//ck 0: Facility a: Approval Number: Lord It xi <br /> A07 � ;� tl (..> ` l• 0 <br /> - Genemtois Nameand Billing Address: Genemtnls Phone N: <br /> s .X.Si•!N i�16.tr•I!Y :!k; , �1t]f� Gt()..'.-k);r4�} <: <br /> - - - - Person to Contact. <br /> 11 + f R1tJ!JJa'1'AIN /Ic`,^ ftr )1� ! <br /> T'rd114'7, la.ry. fIS370 pA7 : Customer A ountNumber - <br /> VA <br /> Consultant's Name and Billing Address: Cnnsultant'sPhonet: .Le <br /> Person to Contact: - <br /> FAX41: Customer Account Number <br /> Generation Site (Transport from); (nante Gnddress) Site Phone 0: ' <br /> COUNTRY fvlAFhh')' Person tnContact: `s <br /> ': e iillV• LihINE• RDAVla <br /> 4 <br /> ti 3Li$31 <br /> }"�?A(�' t':.4CA <br /> Y, 3 PAXa: <br /> VIA I <br /> CAy <br /> C <br /> U Designated Pacility (Transport to): (nnnte &address), - Facility Phone 11 ' <br /> Ck4 <br /> (Sp0) 862.,0161 , <br /> a kiC?IL S tFCA <br /> Person roContact: IV <br /> ! 2 '�Fililc HIBISCUS iAVF(t)11E: fSLLL.: i.r0 . 7cFFIRY <br /> E AC7C.I ANTO , Cv. B:23f)9 PAx#: IAV <br /> phi <br /> 12 <br /> � A <br /> s C ( 760) 2.40-01104 .. Y"' <br /> -,` lkanspaxter Name and Mailing Address: - . . . . . . 1Yansp rtefs Plwne #:Vp <br /> - p" <br /> a inn-o"200 A1t0001 {13BE dt <br /> a SHI RE <br /> Person to Contact. L <br /> 29071 T CYr/ip)>r CEW RE E)RI v{» ICAR V [VI }OTHAR"! 4 1061 7 <br /> FOOT I IILL fiA. .';1 I , (:f%A 02010 FAM: Cu t RlerA tNumber <br /> x <br /> $ESI '1811 . spj <br /> ¢ 6WS�ll i1 x210 <br /> Descrlptton of Sail moistureGontent CoA nilhaled by; Approx Qly; Description of Dsilvery ; Gross AA lit TareWejght Netweighl.. <br /> Sand ❑ _ o ga do ❑ o -10% ❑ Gas oEa <br /> y 10 - 20% . ❑ Diesel <br /> 6i <br /> clay ❑ ober ❑ ao% - over ❑ other ❑ <br /> AM <br /> Stand Ll organic ❑ 0QO% ❑ -fGa - ❑ - : . <br /> da ❑ other ❑ 10- 20% . .❑ Dievel O � ; J <br /> M - cofer Ll <br /> List any exception to items listed above. - - Scale Ticket R . - - - - - i <br /> if <br /> Generator's and/or consultant's certiftcateona/I1.Ne certifij that the soil referenced herein is taken entirely fom1 . thos1 .e sails descried in the Soil Data Las <br /> tCt. <br /> zII, 1 % 1 % <br /> Sleet completed and certified by me/us for the, Generation Site shown above and nothing has been adder! or done to such sod that Would alter it )s, I <br /> in anyway. Mk <br /> Print or Type Name: Generator ❑ Consultant -❑ Signature and date: Month Day Yen ri . <br /> v r Transporter's certificntion: 7/We acknowledge receipt of the soil referell�ed above and certoj that such §w1 is being delwered in exactly the s1 1 <br /> c condition as when received. l/We firriher cerf� that the soil is being directly transported f om the Generation Site to the Desi+ IVgnated Facility "N,; <br /> Qv without off loading, adding to, subtracting froth or m any way delaymg dI .elivery to such site <br /> eName: •,4 / . . . . Srgnatuie Arid date: Matt . D y Y ar.: ",. <br /> Printo/t 7T�qpp L <br /> t- I f 7h 1 <br /> rJr t � F 'r.._I 1 t fill ( ODA ! xJ ,.t?G.c..s. .G ..� 7 � iia *x <br /> Discrepancies: <br /> CiVAC <br /> TS <br /> LL 1bo(D�( l r <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above: E <br /> Ali <br /> Print or Type Name: - srRtt tore snddate; <br /> D A LS <br /> VIC <br /> AC <br /> A Fff1�Y!.I. � FaCJ11Al.irrli, \ . <br /> ff ll <br /> 1 - - . : -.` r .2Rk �* It •'v ri n <br /> pladsa r)nlnrt a . •a., ,%.,:. � � _- .,_ 5 �� n5 • . -: . , . . . . . � <br /> IV <br /> GENERATOR/CONSULTANTS COR-TI,� <br /> IV <br />