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�N�#/,,98 L«"A�4- 9�=/gol / Please pant 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 96 1 (800)424-9300 015481644 J J K 5.Generator's 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 Candini Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Showendan 6.Transporter i Company Name U.S.EPA ID Number 7.Transporter Company Name U . PA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttornvillow,CA 93206 Facilrtys Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9, 9b,U.S.DOT Description)including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Pecking Group(it any)) No. Type Quantity Wt'Noi. 1 6 1 1 D008 i 0 NA3077,Hamrdous Waste, Solid,N.O.S.,(Lead),9,PG III 0 0 1 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 12 3 12 B Vegetation 0-5% Wear appropriate Personal Protective Equipmert as necessary 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental 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 261(if I am a large quantity generator)or(b)fif l am a small qui generator)is true. Generatoes/Olferors PdntedRyped NameSignatur Month Day Year (ori b"lf of the City of Manteca) 3 1 C o 1 16.International Shipments ❑Import to U.S. ❑Export from U.S. o of entrylexiC r Transporter signature(for exports only): leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Month Day Year Trans nntedlTy Name Signatu a C, QTran rt Pnnted/Type ame Si re Month Day Year K H } 18.Discrepancy 18a.Discrepancy Indication SpaceL1❑ Quantity Ll Type ❑Residue Partial Rejection Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: W 18c.Signature ofAltemate Facility(or Generator) Month Day Year t- 6 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. l , YZ 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PnntedRyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)