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,/9 01:07:00 p.m. 09-29-2011 4/4 <br /> w <br /> REPUBLICS, ERVICESO INC. <br /> � <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR INFORMATION CUSTOMER/BILLING INFORMATION <br /> ACTON MICKELSON ' <br /> DenerntorNnme: GEORGIA PACIFIC CORP. Billing Name: ENVIRONMENTAL INC. <br /> Address 133 PEACHTREE ST.NE Address 1107 INVESTMENT BLVD#290 <br /> City: ATLANTA County: city: EL DORADO HILLS County: <br /> sato GA zip: 30303 sate: CA zip: 95762 <br /> Site Location(ifdilraren0; 75 W. VALPICO ROAD TRACY , <br /> Republle Servlees Description of waste Volume/welght Expiration Container Type <br /> A roval# Date <br /> 38501115486 CONTAMINTED SOIL ADC 60/CY 3/31/2012 <br /> }Attach Additional Sheet if necessary , <br /> 1 hereby certify that the above described materials are nonhazardous wastes as defined by 40 CFR 261 or any applicable state law. <br /> Further,that the above named materials are properly classified,described,packaged,marked and labeled,and are in proper <br /> ltion for transportation according tot a applicable regulations of the Department of Transportation. <br /> Aid <br /> abeV <br /> Generator/Authorized Aecnt Name V Siannture Date Shipped <br /> `T.O/, of• "fir!'i s-" <br /> TRANSPORTER INFORMATION <br /> Transporter Name: L / j DOT# ✓ -' O <br /> Trans orter Address: "' l� <br /> p �i r_c! �'fUiri:�% 1?iri�<�p Truck Number: <br /> Phone Number: <br /> I certify no hazardous waste or other regulated subs[anee'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 knowledge. s <br /> `�,,��-7 !'/_ . ��'/�nC `✓�s'. r,'t�f'j�r// �;;_':';-:_,,.ice,,/'_./�f <br /> Name of Authorized Agent Signature /f Date 17elivered <br /> DISPOSAL SITE INFORMATION <br /> S e SCO-ROAD LANDFILL Phone No. 925 447 0491 , <br /> Site Addr 4001 VASCO ROAD LIVERMORE CA <br /> Lereby kmo'e@fe ithe above de cribed materials.ara � ��,�69� . <br /> Name apIrint orType)- Signature Date Received ' <br />