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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.GggerytoplDlJWnharO 9 5 9 9 6 2.Pape loll 3.Epyggr Res�sePhone 4.Manifest Tracking Number <br /> WASTE MANIFEST ll..:A LL UU U UU f lou"J 4l 3110 015481619 JJ K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> City of Manteca City of Mantra <br /> 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 <br /> Generators Phone:(209)456-8415 Attn: Greg Shown rman <br /> 6.Transporter 1 Company Name U. A ID Number Q <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 8,Desi aced F iNwNap�e andSitaAddress U.S.EPA ID Number <br /> 125500 West Lokern Road,Buttonwillow,CA 93206 <br /> (661)762-6200 CAD980675276 <br /> Fadi s Phone: <br /> ga 9b.U.S.DOT Description including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Padding Gmup(8any)) <br /> No. Type OuanDry Wt.Nol. <br /> 1. <br /> do <br /> 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 0 0 1 D T 18 Y <br /> w <br /> z 2. <br /> w <br /> C9 <br /> 3. <br /> 4. <br /> 14.S al Handling Instructions and Additional Information <br /> Sal: 95-100% Clean Harbors Profile Number: C H 1 3 12 3 12 B <br /> Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 33 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeled(placarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowfedgment of Consent. <br /> I ca"that the waste minimution statement identified in 40 CFR 262.27(a)(if I am a large quantity gemirator)or(b)(it I am a small quantity ernmintor)is Due. <br /> Generiders/Oeerors Printed/fyped Name (onbehalfofthe City ofMaraeca) Signature Month pay Year <br /> 3e <br /> J 16.International Shipments <br /> ❑Import M U.S. ❑Expert from U.S. Port of atry/exit <br /> Transporter signature(for exports oni Date lea U.S.: <br /> W 17.TranspaterAcknowledgment of Receipt of Materials <br /> Transporter 1 Prinkid[Tirced Name <br /> ya <br /> Signature DYear r <br /> A P012 <br /> re MM <br /> Z Transporter Prinledoryped Name onth Diy Ye <br /> at <br /> K <br /> H <br /> .} 18.Discrepancy <br /> 18a.Discrepancy Indication Space EJ <br /> Quanary 11 Type ❑Resitlue ❑PeNel Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 186.Alternate Facility(or Generator) Manifest <br /> EPA ID Number <br /> J <br /> U <br /> Facility's Phone. <br /> W 18c.Signature ofAftemate FadBty(or Generator) Month Day Year <br /> z <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1_ 1 -L 1 <br /> 2. 3. 4, <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedtryped Name Sgnature y ear <br /> EPA Form 8700-22(Rev.3 5) Previous editions are obsolete. DESIGNATED FACILT TO D TIN TION STATE (IF RE UIR D) <br />