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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 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481625 JJK_ 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) City of Manteca 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.Transpofiipany N n %� U.S.EPA ID Number aI Com'l_4C_ i 7.Transporter 2 Company Name U.S.E7PA ID 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 C A D 9 8 0 6 7 5 2 7 6 9a 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(if any)) No. Type Quantity Wt.Nol. 1 6 1 1 D008 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 0 0 1 D T 1 8 Y z 2. LJ c� 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 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 labeled/placarded,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 certify 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 quantityaerator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year (on behalf of the City of Mardeca) JWu Lk_hi ' I 16.International Shipments _ F. ❑Import to U.S. Export from U.S. Port of e trylexit: Transporter signature(for exports only): Date lea g U.S.: 17.Transporter Acknowledgment of Receipt of Materials LLJTransporter 1 Print Typed Name Signature Month Day _ Year AgmLo, z Transporter 2 Prin edfryped Name Signa e Month Day Year Q � f H 18,Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181 Alternate Facility(or Generator) U.S.EPA ID Number J ii Facility's Phone: Month Day Year Lu 18c.Signature of Alternate Facility(or Generator) Q 3 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1 �fI3 Z 2 3 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name I Signature Month Day Year I Z. s' /J EPA Form 8700-22(Rev.3-05) Previous editions are obsole . DESIGNATED FACILITY T DESTINATION STATE (IF REQUIRED)