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Please Print or type.(Form designed for use on elite(12-pitch)"minter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 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 015481632 JJ K 5.Generators Name and Mailing Address Generators Site Address(if 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)456-8415 Atte Greg Showerman 6.Transporter 1 Company Name U.S.EPA ID Number �-- 10a 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttomvillow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 CAD980675276 9s 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit HM and Packing Group(ff any)) No Type Quantity WLA/oL 13.Waste Codes z 1' 611 D008 O NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 18 Y Z 2. w I 3. f i 4. I 14.Special Handling Instructions and Additional Intonation Soil: 95-100% 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 Iabelecilplacarded,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 certlfy that the contents of this consignment conform to the terms of the attached EPAAcknawledgment of Consent. I certify that the vrdsle minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(8I am a small quantityerotor)is true. GeneramrslOfferors Printed7Typed Name Signature Month Day Year (onbehalfofthe Qty ofMadill I >L� 8 .l 16.International Shipments F Elimportto U.S. ElExpertfrom U.S. Port of /exit: 31 Transporter signature(for exports only): Dale leaving U.S. w 17.Transporter AcknoWedgment of Receipt of Materials Transporter 1 Pnntedrryped Name Signature Month Day Year y12 p Lao zicaO QTransporter 2 Printetllfyped Name Signature Mon Day Year C f i18.Discrepancy 18a.Discrepancy Indication Space 1:1Quantity ❑Type 11Residue ElPanelRejection LlFull Rejection Manifest Reference Number IBB.Alternate Fadi(or Generator) U.S.EPA ID Number J U 1 Facility's Phona: 1 B.Signature of Altemate Facility(or Generator) Month Day Year a z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G I, ( 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 PnntedlT Namr jo S t Signa Month Day Year 6 111 EPA Form 8700-22(Rev.3-05) Previous edifionsare obsolete. DESIGNATED FACILITY DESTINATION STATE (IF REQUIRED)