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1 COPY 1 <br /> & REPUBL ' <br /> fC <br /> SERVICES, INC. <br /> NON-HAZARDOUS WASTES MANIFEST <br /> GENERATOR INFORMATION CBSTONIER/BILLING INFORMATION <br /> Generator Acme_ TEMPLE INLAND Billing Mame: TEMPLE INLAND <br /> Address PO BOX 1029 _ Address PO BOX 1024 <br /> City: TRACY County: City: TRACY County: <br /> i <br /> Srate CA Zip: 95375 Stats CA Zip: 95378 <br /> Site Location(if difrcrent): 400 W.VALPICO ROAD TRACY <br /> Republic Services Expiration <br /> Approval# Description or Wasto VolumelWeight Dxte Contaiaer Type <br /> 1001PER <br /> 3850Y915124 FILTER CAKE YEAR 10/1212012 <br /> , <br /> *Au=h Additional Sheet if necessary <br /> I hereby cartify that the above described materials are non-hazardous wastes as defined by 40 CFR 261 or any applicable state law. i <br /> Further,that the above named materials are properly classified,describ4 packaged,marked and labeled,and are in proper <br /> condition for transportation according to the a1pplicable regulations of the Department of Transportation. � <br /> GcneEltor/Autkodzed Agent Name S1271121tyre Date SMnoed t <br /> 1,,,� TRANSPORTER INFORMATION 1_ <br /> Transporter Name: r �10' a�, I L)!4 0yk�CQ��� AOT# IV q'9 <br /> Trans er Address: A <br /> port fo U Track Number: <br /> 9-S0-10r ¢ Ile,1 Co _ Phone Number. I0 7. $ Q L( <br /> f <br /> I certify no hazardous waste or other regulated substance was knowinglyin uced to the waste while in nay custody. The waste <br /> transported in this vehicle is the►yaste i entified above,to the boQf m owledge_ <br /> Name of Authorized en Signature Date Delivered <br /> r <br /> DISPOSAL SITE INFOR ATION <br /> Site Names, VASCO ROAD LANDFILL Phone INC. 925.447-13491 <br /> Site Address= _ W_ 4001 VASCO ROAD LIVERMORE,CA 94550 _ <br /> I hereby acknowledge receipt of the above described materials. <br /> Marnc(Print or T;IQe).y . 5i9mnnr .�.�....— Date!te.:ci•:Cd <br />