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(� 0 327'i"IP A44 36/r Y/-a 9 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 1 015481628 J J K 5.Generators Name and Mailing Address Generators Site Address(it different than mailing address) City of Manteca (Sty of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Carl Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn:Greg Showerman 6.Trans mpanyNpA U.S.EPA ID Number -e� 64thm 173 &72---- 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 Lokem 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,Heard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes HM and Patting Group(it any)) Na. Type OuanPoy wt. 1. 6 1 1 1DO08 K qa NA3077,HazardousWaste,Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 18 Y z Z. Ulu 4. 14.Special Handling Instructions and Additional Intonation Scil: 95-1000/0 Clean Harbors Profile Number:C H 13 1 2 3 12 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'WOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, marked and Iamedlplacarded,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 celtily,that the waste minimization statement identified in 40 CFR 26227(8)(g I am a large quantity generator)or(b)(if l am a small quantity ge tar)is true. Genemtoes/OBemes PrinledrTyped Name Signature Month Do Year (onbebalf of the City of Manteca) - 16.International Shipments p_ ❑Import to U.S. Export from U.S. PM of entry xd: = Transporter signature(for exports only): leaving .5.. w 17.Transportergment of R 'pt of Matenals � Transport P' edR Na Sig re Month �y Year a4110& k 147- aTransporter 2 Printed/T Name Signature Month Day Ybar K } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Par al Rejection ❑Full Rejection Manifest Reference Number: 18b.ABemate Facility(or Generator) U.S.EPA ID Number J U LL Facililys Phone: Maj l9c.Signature of Ahemate Facility(or Generator) Month Day Year 6 2 h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. IV/sz 20.Designated Facility Owner or Operator:Certification of receipt of haxardDUS materials covered by the manifest except as noted in Item 18a PrintedRyped Name ,✓ Signature Month Day Year olr+t Cc �wo� m. EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)