2016-04-12_GENERAL DOCUMENTS - M1977089

• Permit No: M1977089
• IBM Index Class Name: General Documents
• Doc Date: 4/12/2016
• Doc Name: Correspondence
• From: Stone Sand & Gravel, LLC
• To: DRMS
• Media Type: D
• Archive: No

- it„ CONTRACT ENVIRONMENTAL SERVICES INC.
925 S. Broadway, Ste 251 • Cortez, Colorado 81321 • 970-565-1198
Landfarm Soil Delivery Manifest
Landfarm Location: NE1/4, S18, T39S, R26E, San Juan County, UT
/certify that this is RCRA-exempt Oilfield Waste, Signed:
Delivery Date (mm/dd/yy): Delivery Time:
Volume Delivered (est. cu. yd.):
Description (soil type, color, etc.):
Soil Origin and Generator Information:
Location or Well name:
Section: Township: Range: Qt/Qt or U.L.:
Generator:
Address:
Phone:
Send Invoice to (if different from above):
Name: Job or P.O. no.:
Company:
Address:
Phone:
Transporter Information:
Trucking Company:
Address:
Phone:
Driver: Truck Number:
Time left site: Time arriving at landfarm:
Remediated soil will either (check one): "GPS" N
LI remain at landfarm, or
❑ return to its originating location.
Depositing Information: 3 2 1
Grid Number Deposited In:
Individual Grid
45
Shade in approximate area 4 5
accounted for by the soil in the 9 8 7
appropriate grid square:
Soil Contamination Data: 10 11 12
Field headspace:
TPH: SAR: 15 14 13
Elec. Cond:
EPS: 16 17 18 REPROGRAPHICS 111.119C
Date tested: V