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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.Emergenq Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481630 JJ K 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Ci(y of Marrieca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candim Drive,Manteca,CA 95337 Genemthrs Phone:(209)456-8415 Attn: Greg Showerman 6.Transporter 1 Companoame U.S.EPA ID Number C 1w boo 7.Tmnsporter2Com ny We 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 g2 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Pacldng Group if any)) No. Type Quantity Wt.NOI. (If 1. 6 11 DW8 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 18 Y ? z 2. w 4 3 I 4. I 14.Special Handling Instructors and Additional Information Sail: 95-1000/o Clean Harbors Profile Number: C H 13 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 Iaheledlplacarded,and are in all respects in proper condition for transport according to applicable intemalional and national governmental regulations.If export shipment and I am the Primary Exporter,I partly that the contents of this consignment confirm to the terms of the attached EPA Acknowledgment of Consent. I partly that the waste minim¢ation statement identified in 40 CFR 262.27(x)(f I am a large quantity generator)or(b)(if I am a small quanti enerator)is true. GeneratorstOferors Pnnled7Typed Name Signaturet_.., Month Day Year (on behalf of the City of Manteca) /`J` —11 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of el trylexn: Transporter signature(Mr exports only): Date leaving U.S.: w 17.TransporterAclmoodedgmem of Receipt of Materials Trmspo r 1 Printed/Typed Name SignaNre Month Day Year N 3 /6 Transporter 2 Pnnted/Typed Name naW Month Day Year C F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Typej ❑Resitlue ❑Penial Re edion Full Rejection Manifest Reference Number. 18b.Afemete Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Sgnature of Alternate Facility(or Generator) Month Day Year ZZ H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dispersal,and recycling systems) C a. t ' � -x 2. 3, 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 180 Printedr Name z Signature Month Day Year C� � ti0 S d9�► U ZZ 6 17 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)