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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 I 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 015481629 JJ K 5.Generator's Name and Mailing Address Generators Site Address(H different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candim Drive,Manteca,CA 95337 Generators Phone: 209 4568415 Attn: Greg Showennan 6.Transporter 1 Company Name ,� U.,1 IJPA ID Number 4 00 7 8 2. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number BUttORR7Ilow Landfill 2500 West Lokern Road,Buttomwillow,CA 93206 Facility's Phone:(661)762-6200 CAD 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(8 any)) No. Type Quantity Wt.Nol. 1 611 DW8 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 1 8 1 z 2. w 3. I I 4. 14.Special Handling Instructions and Additional Information Soil: 95-1000/a Clean Harbors Profile Number:C H 13 12 3 12 B V on:0-5% Wear apgopinate Personal Protective Equipment as 33 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare 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 modify that the contents of this consignment conform to the terms of the attached EPAAckncwledgmenl 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)(dl am a small quantity generator)is we. Generators/Offerors Printed/Typed Name Signatum Month Day Year (onbehalf of the City of Mattaca) A-UUUA- - 3 8 l J 16.International ShipmentsEl r ❑Import to U.S. Export from U.S. Part o n lexis. Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials IJJ Transporter 1 Printe Y'Pe/Name aSigns Month Day yea4. O `_ U fa /17 H zQ Transporter 2 Printed(Typed Name Signature onN Day Year K r ♦ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ou entity ❑Type ❑Residue ❑Parbal Rejection ❑Full Rejection Manifest Reference Number: 18b.Memate Faulty(or Generator) U.S.EPA ID Number J U LL redlllys Phone: W 18c.Signature of ARemate Facility(or Generator) Month Day Year Q 2 N19.Hazardous Waste Report Management Method Codes(i.e.,codas for hazardous waste treatment,disposal,and recycling systems) 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnntedrryped NameO �-S Signature Month Day Year EPA Form 8700-22(Rev.3-05) re rouse it ns are obsolete. G DESIGNATED FACILI VTO ST ATION STATE (IF IEC UIR D)