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01:07:00 p.m. 09-29-2011 414 <br /> 60 O REPI.�If'Lr/�' <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR INFORMATION CUSTOMER/BILLING INFORMATION <br /> ACTON MICK.ELSON <br /> ' Billing Noma ENVIRONMENTAL INC. <br /> OenemtorNnmo; GEORGIA PACIFIC CORP. Address i1D7INVESTMENT BLVD#290 <br /> Address 133 PEACHTREE ST.NE <br /> A County; �__.--- City' EL DORADO HILLS County: <br /> city: ATLATLANTT --- zip: 95762 <br /> ZI <br /> State GA 1'' 30303 state: CA.--------"' <br /> i <br /> Site Location(if dtlrerenq; 75 W.VALPICO ROADz TRACY <br /> Expiration ContninerType <br /> RepubI es ervices Description of Waste VolumelWelght Date <br /> ' A rovalfl6 C60/CY 3/31/20I2 <br /> 3850111548ONTAMINTED SOIL-ADC <br /> *Attach Additional Sheet if necessary <br /> 40 CFR 261 <br /> ' Further that the that <br /> above aboveamed mes�flbed materials are non�hnzardous Wastes as dofined aterials are properly classified described packaged,mark d and labeledrand are pic properable law. <br /> Pndltlon for transportation according to a Opp <br /> 11 ablo regulations orthe Deportment of Transportation. <br /> u�i N �� Date Slt{noed <br /> Generator/Authorized A—ell <br /> S{nnature <br /> TRANSPORTER INFORMATION <br /> l.c7l <br /> ' <br /> Transporter Name; DOT# <br /> $fl CAS i <br /> Truck Number; t�S <br /> Transporter Address: �i7 �F rvt rFl ft (�lY+-{l!_h <br /> Phone Number: <br /> t I certify no hazardous waste or other regulated substance was knowingly introduced to the waste while in my custody. The waste <br /> transported in this vehicle is the waste identified above,to the best of my kno /y <br /> y1 �� �iYcL i e <br /> SSr nature Date Delivered <br /> Name of Authorized Agent <br /> ' DISPOSAL SITE INFORMATION <br /> Phone No. 925 447 0491 <br /> Site Namel <br /> VASCO ROAD LANDFILL <br /> Site Addresst �p �, 4001 VASCO ROAD LTYERIVIORE CA <br /> Iherby c1og� F4v- "'edesc badmaterials, <br /> ' Intl Date Received <br /> SignatureName(Piintor lwa'fO -�f.OLt: <br />