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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST I CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481621 J J K 5.Generators Name and Mailing Address Generators See Address(if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candiru Drive,Manteca,CA 95337 Generators Phone: 209 456-8415 AttrulJORShowerman 6.Transporter CompaarNeele U.S.EPA ID Number a q O t 7.Transporter 2 Company Name U.S. PAID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9a. Sb.U.S.DOT Description(including Proper Shipping Name,Hazard ClasS,ID Number, 10 Containers 11.Total 12.Unit 13 Waste Codes HM and Packing Group(H any)) No. Type Quantity WIJVOL cc 1. 6 1 1 ID008 QO C NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 00 1 D T L 8 Y i 2. w c� 3. 4 4. 14.Special Handling Instructions and Additional Information Soil: 95-1000/0 Clean Harbors Profile Number: C H 13 12 3 12 B Vegetation:0-5% Wear appropriate Personal Protective Equipment as necessary 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, marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I codify that the waste minimization statement identified in 40 CFR 262.27(a)if I am a large quantity generator)or(b)(if I am a small quant generator)is true. GenemlorslCifferors Pdnted7fyped Name Signature Month Day year (onbelmalf of the City of Manteca) I 8 1 16.International Shipments � ElImportto U.S. E>mon from U.S. Port of a /exit Transporter signature(for expods only): Date lea U.S.: W 17.TransponerAcknowledgment of Receipt of Materials K Transporter 1 P yped Name Signature Month Day Year Q. 4S !")1 c�c > Q% Transporter 2 PdntedfTyped Name Sig tun Month Daiy Year r I 18.Discrepancy 180.Discrepancy Indication Space El Quantity ❑Type ElType ❑Pamal Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facilitys Phone w 18c.Signature of Alternate Facility(or Generator) Monty Day Year Q Z (D 19.Hazardous Waste Report Management Method Codes lie,codes for hazardous waste treatment,disposal,and recycling systems) W I 2, 3. 4. D 20.Designated Fadlity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Nem 180 Pnnted7TyW Name . LAI Lrs �� Signature Month ;y Year EPA Form 870D-22(Rev.3-00,5)))PPrevious editions are obsolete. 1 DESIGNATED ACILITtTYDESTINATION STATE (IF REQUIRED)