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12 t3pm 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 1 of 3.Emergency Response Phone d.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481624 JJ K 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) City of Manteca Qty of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone.(209)456-8415 Attw Greg Showerman 6.Transporter 1 Company Name f� U.S. ID Number © /\ 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Bultanwlllow Landfill 2500 West Lokem Road,Buttorrwillow,CA 93206 FaclIM/s Phone:(661)762-6200 CAD980675276 ga 9b.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(it any)) EID Quantity Wt.Nm. z 6 1 l D008 0 NA3077,Hazardous Waste,Solid,N.O.S.,(Lead),9,PG 111 1 8 3' z 2 w 3. . 41 4, 1—+—±- 14.Special Handling Instructions and Additional Information Sail: 95-100°/6 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 laheledlplacmded,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 Pnmary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. GeneratorslORerors PdntedlTyped Name Signature Monts Day Year (onbaW of the City of Martai 16.International Shipments J1 Lu� F ❑Import to U.S. Export from U.S. Port ofnlrylexit: Transporter signature(for exports only). Date leling U.S.: K 17.Transporter Acknowledgment of Receipt of Materials UJI Ii Trensporteri PdnledR N e /� Signature Monts Day Year a K QTransporter 2 PnntedfTyped Name Signature Month Day Ye K F 18.Discrepancy 18a.Discrepancy Indication Space ❑ chummy ❑Type ❑Residue ❑Partial Rejection ❑Full Raleceon Manifest Reference Number. 18b.ARemate Facility(or Generator) U.S.EPA ID Number J 4-Y ua. Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Monts Day Year a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. 4. 20.Designated Facility Owner or Operator.CeNfiwtion of receipt of hazardous materials covered by the manifest except as noted in Item 18a Il Pnnted4 ped Name i Signa tur Monts Day Year �it O S l 1 EPA Form 8700-22(Rev.3-05) Previous editions areobsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)