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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.Emergency Response Phone 4.Manliest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481633 J J K 5.Generator's Name and Mailing Address C jmflors Site Address(n different then mailing address) City of MaNeca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone: 209 456-8415 Attri Girl Showerntan 6. nsporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.E A ID umber 19S C;ZS 8.Designated Facility Name and Site Address U.S.EPA IO Number Buttonwtillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Fadll ys Ph..:(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(f any)) No. Type Quantity Vill 1. 6 1 1 DON O NA3077,Hazardous Waste,Solid,N.O.S.,(Lead),9,PG HI 001 D T 18 Y z 2. W 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 1 2 3 12 B Vegetation 0-5% Wear appropniate 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 Iabeled1plaarded,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 cantly that the contents of this consignment conform to tiro terms of the attached EPAArknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(f l am a large quantity generator)or(b)(ifI am a small quantity n r)is rine. GeneratorsrOferars PdntedrTyped Name Signature Month Day Year (on behalf of the City of Mtmfaca) 1 's I 8 I I F tfi.International Shipments ❑Import to U.S. ❑Export from U.S. Port of /eidt — = Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Admowledgment of Receipt of Materials Tra 1 Printed(Typed Name / Sigrate Month Day Year a Q rJ d isli7G.Z- QTransporter Printed(Typed Name ignature c5r ZMonth Day Year K I 18.Discrepancy I� 18a.Discrepancy Indication Space Elouantity ❑Type ❑Residue J Partial Rejection Full Refectionn Manifest Reference Number 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U rat Faalil Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q 2 H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 2 3. 4. 20.Designated Facility owner or Operator:Certification of recall of hazardous materials covered by the manifest except as noted in Item the PrintedrTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)