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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 F3.Emergency Response PhoneManifest Tracking Number WASTE MANIFEST C A L 0 0 0 0 9 5 9 9 6 1 4.(800)424-9300 015481626 JJ K 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 Generator's Phone:(209)456-8415 Attn: Greg Showerman 6.Transporter 1 pany Name � U.S.EPA I N ber 7.Transporter 2 Company Name U.S.EPA 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 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./Vol. 1, 0 6 1 1 D008 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 00 1 D T 18 Y w Z 2 w t� 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 3 12 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GEN ERATOR'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 quart enerator)is true. Generator's/Offerors PrintedlTyped-NameSignature Month Day Year (on behalf of the City of Manteca) 8 1 J 16.International Shipments r— ❑Import to U.S. ❑Export from U.S. Port of e trylexit: Transporter signature(for exports only): — — Date lea ng U.S.: 17.Transporter Acknowledgment of Receipt of Materials U Transpo edT ped Na Sign Month rDay Year CL QTransporter 2 Printed/Typed Name Signature t Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: J U.S.EPA ID Number U LL Facility's Phone: W 18c.Signature of Altemate Facility(or Generator) Month Day Year Q Z N19.Hazardou aste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. �� 2. 3. 4. 20.Designated Facility Owner erator:Certification of receipt of hazardou aterials covered by the manifest except as noted in Item 18a Printed/Typed Name M nt Da Year �2 ' l / EPA Form 8700-22 ev.3-05) Previous editions are o olete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)