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Please print or type.(Form designed for use onn,Nelite hIf 2-pitch)typewriter.) Form Approved.OMB No.2050-0039 ZA UNIFORM HARDOUS 1.GC�;u 1u'O 9 5 9 9 6 2.Pape 1 of 3.Erpgg y r YnVb ne 4.Manifest Tracking Number WASTE MANIFEST l��"1 Jl1U 015481620 JJ K 5.Gepggrss pV anVkeMOaang Address Generator's Site Address(8 different than mailing address) ty II MM City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn:Greg Showerman 6.Transpo mpan U.S.EPA ID Number. 7.Transporter Coopan amen U.S.EPA ID Number S.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Loi Road,Buttonwillow,CA 93206 (661)762-6200 CAD980675276 Fadlitys Phone: 93 9b.U.S.DOT Description(including Proper Shipping Name Hazard Class.ID Number, 10 Containers 11.Total 12.Ung 13.Waste Codes HM and Packing Group(H any)) Ido type Quantity WLNd. 1, K O NA3077,Hazardous Waste, Solid N.O.S.,(Lead),9, PG III 00 1 D T 1 8 5' z 2. w r, 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-1000/0 Clean Harbors Profile Number:C H 13 1 2 3 12 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'SrOFFEROR'S CERTIFICATION: I hereby declare that he contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and Iabeledlplacarded,and are in all Impacts in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certrfy that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Consent. I dandify that the waste minimisation statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity relator)is true. GeneratorslOBeror's Printedrryped Name (On tlehalfofUle City OfMeNaca) SignaNre �.p Month G Year / \ cLUL11A7r 16.International Shipments F ❑Import to U.S. ❑6portfrom U.S. Port of en /ex8: Transporter - ature(for exports only): Date leavin U.S.: w 17.TraArterknootedgarient of Recei t of Materials Tran lint Name ign Month , Yea a _ N zQ Tran rter2 Print Name nature MonthAT ay ear K H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j ❑Partial Rejection Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Faulity's Phone. W 18c.Signal ofAhemate Facility(cr Generator) Month Day Year Q Z H19.Hazardous Waste Repot Management Method Codes(i.e.,codes for hazardous waste tr'eabtrent,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials cavered b2 . y the manifest except as need in Item Ise - NnledfTypedNam �v> O� , 1 �Z Signature Monty ,Oay year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. Ill �C/� DESIGNATED FACILI TO DES I ION STATE (IF RIEOUI`/R D)