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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 t.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481622 J J K 5 Geperatars and Mailing Address Generators Site Address(if diferent than mailing address) 71"W�eseT�er Stre Monte CA 95337 4 of Manteca 1077 Milo Candird Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6,Transporter 1 Company Nam U.S.EPA Number GR m2 1D 7.Transporter ticenliany Rame U.S.EPA ID Winter 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttottwinow Landfill 2500 West Lokern Roel,Buttonwillow,CA 93206 Facilitye Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group if any)) 13.Waste Codes No. Type Quantity Wt/Vo1. 1 61 1 D008 O NA3077,Hazardous Waste, Solid,N.O.S.,(Leat!),9,PG III 0 0 1 D T 18 Y W Z 2. W x9 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100•/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'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.H export shipment and I am the Primary Exporter,I pertly that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimisation statement identified in 40 CFR 262.27(a)(H I am a large quantity generator)or(b)(if I am a small quantitynerator)is true. Generator's/Ofemes Printed7iyped Name Signature Monts Day Year Ij (oabahalfofthCityofMstaca) CL A -Adn� 16.Intema6onal Shipments i ❑Import to U.S. ❑Export from U.S. Port of e/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed N Signa / Monts Day / Year W Transporter PrintedR ed Name Signature Month Day Year H ♦ 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejecfion Manifest Reference Number: 18b.AHemate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature ofAltemate Facility(or Generator) Q Monts Day Year Z y19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) p 1. I J Z 2. 3. 4. 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covead by the merriest except as noted in Item 18a PrintedRyped Name Signature I �� 9 Monts Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILI YTO DE TION STATE TI (IF REOUIR D)