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01:07:o0P.m. 09-29-2011 414 <br /> REPUDLIC <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR INFORMATION CUSTOMEACTON RJBlLLINGINFORMATMCKELSON ' <br /> [3iI1intiName; ENVIRONMENTAL INC. <br /> ocnemlorNnmc; GEORGIA PACIFIC CORP. ' <br /> Address 133 PEACHTREE ST.NE Address 1107 INVESTMENT BLVD# 290 <br /> City: EL DORADO HILLS County: <br /> City: ATLANTA County; ___._ <br /> �— State; CA Zip- 95762 <br /> State GA. _ zip; 3030_---33 <br /> Site Location(1fd1ffen nQ; 75 W.VALPICO ROAD TRACY <br /> Expiration Container Type <br /> lWeight Date <br /> Republic Services Description afWaste volume[Weight <br /> A rovnl# 601CY <br /> 38501115486 CONTAMJNTED SOIL-ADC , <br /> *Attach Additional Sheet if necessary y applicable state law. <br /> defi <br /> ed <br /> I hereby certify that the above described Materials r classified,described,packaged marked and labeled,and are proper <br /> Further,that the above named routed are properly ' <br /> Pedition for transportation according to c appllcablo regulations of the DepartmelltofTransportntion. <br /> i y ' <br /> 4PZKgla. Parc- �Lt; <br /> U li 8 ,, � Date 8hlon?d <br /> Generntor/Author-izeyd AJeent ane <br /> Slennture , <br /> TRANSPORTER INFORMATION <br /> _ DOT# <br /> Transporter Name: T f 4F�C 1A)C' a f Truck Number; 2n r <br /> Transporter Address: (r2Z) � rw1 r )t, .i_] Phone Number:`""" f_ Irl <br /> I certify no hazardous waste or other regulated substance was knowingly introduced to the waste while in my custody. The waste <br /> e waste identified above,to the best of my}uiowladg <br /> transported in this vehicle is th <br /> �UrWf !�1?a'�°7 �` Sig 1 i Date fileltvered ' <br /> �-- hue <br /> Name of Authorized Agent <br /> DISPOSAL SITE INFORMATION <br /> Site Name; <br /> VA9C_0 ROAD LANDFILL Phone No. 925 447 0491 <br /> R' ,; 4001 VA SCO ROAD LIVERMORE CA ' <br /> s MIN <br /> I ereby acknowledge receipt of the above d7cribed materials. <br /> OCT 242011 <br /> `v i 1 K I led <br /> Date Received <br /> -Signature <br /> Namt(Pq rintorTYp Mrl' CA _ <br />