FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

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 015481631 J J 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 er o > 23.2 7.Transporter 2 Company Name U.S.EPATD 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 9a, 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)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. 0 6 1 1 D008 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG I11 00 1 D T 18 Y w w 2. c� 3. 4. 14 Special. Inst actions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 3 12 B IV etation: 0-5% Wear anpropriate Personal Protective Equipment as necessary 15. GENERATOR'S/OFFEROR'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 if I am a small quantity) O( q ty ge rotor)is true. Generato slOfferorsPdntedTypedName Signature ,� (on behalf of the City of Manteca) :11/ Month Day Year -J 16.International Shipments 8 ❑Import to U.S. ❑Export from U.S. �Portoit Z Transporter signature(for exports only): -- - -- It 17.Transporter Acknowledgment of Receipt of Materials Date leaving U.S.: OTransporter 1 Pdn_tedlTyped Na Signature 0 Month Day Year Q Trans ter 2 rinted/Typed Name 3 I X Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 ❑Full Rejection 18b.Alternate FacilityManifest Reference Number- -J (or Generator) -J U.S.EPA ID Number U �! Facility's Phone- w 18c.Signature of Alternate Facility(or Generator) Z Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w1 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/T ped Name Signatur aK O _o/� r i t�� Month D/ay Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolet . u DESIGNATED FACILITY TO D ATION STATE (IF REQUIRED)