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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 CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481627 J J K 5.Generators Name and Mailing Address Geromm''s Site Address if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo CuKhTli Drive,Manteca,CA 95337 Generators Phone: 209 45(5-8415 Atte Cffm Showetman 6.Transporter 1 Company Name U.S.EPA ID Number 7. nspoder 2 Company Name .S.EPA ID mbar 8.Designated Facility Name and Site Addri U.S.EPA ID Number Bu tonwillow Landfill 2500 West LOI Roel,Buttonwillow,CA 93206 Facitiys Phone:(661)762-6200 CAD 980 6 75276 gra, 9b.U.S.DOT Description(including Proper Shipping Name,Heard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(H any)) 13.Waste Codes No. Type Quantity Wt.Nd. 1. r 6 11 D008 NA3077,Haardoin Waste, Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 1 S Y z 2. I fW7 3. 4. 1d.Special Handling Inshuctions antl Additional Information � Soil: 95-100% Clean Harbors Profile Number: C H 13 1 2 3 1 2 B . on 0-5% Wear appropriate Personal Protective Eginlifu nt as necessary 15. GENERATOR'S/OFFEROR'S CERTIFICATION: hereby declare Nat Ne contents of this consignment are fully and aaumtely described above by the proper shippng name,and are classified,packaged, marked and labeled/placartletl,ccntl are in all respects in proper mndNon for transport according to applicable international and national governmental regulators.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 partly that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quantity nerator)is ime. Generatoes/OReWs Printedrryped Name SignaNre� (onbelmtfofthe City ofMariam) Month D F16.International Shipments ❑I ❑E rtfrom U.S. Pok44 mporttoU.S.ransportersgnalura(for exports onty)17.Tran sporterAcknOwledgmentofRecept of MaterialsTransporter 1 Printedrfypedy vI Transporter2P' ypndName } 18.Disaepancy • 18a.Disaepanny Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full RejedYear [" 18b.Afiemate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number U LL Facil l Phone: ow 1So.Signature Of Alternate Facility(or Generator) ZMonth Day G19.Hazardous Waste Report Management Ml Godes(i.e.,codes for hazardous waste treatment,tlisposal,antl reryGing systems) 3, a 20.Designated Facility Owner or Operator.Certification of recaipt of hazardous materials wvered by the manffest ex t as noted in Item 18a VIII' Printedrryped Name I �-----�a n v i Signa tu Month Oay Year EPA Forth 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)