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31 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 015 4 816 4 9 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 GeneratovsPhorm(209)456-8415 Atte: Greg Showerman 6.Transporter 1 Company Name U S.EPA 10 Number G 7.Transporter 2 Company Name U. .EPAD N Iumber 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttormllow Landfill 2500 West Lokern Road,Buttortwillow,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 13.Waste Codes HM and Packing Group(9 any)) No. Type Quantity Wt Nol. 1. 6 1 1 D008 K O NA3077,Hazardous Waste,Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 18 S z 2. W 3. I 4. t 14.Special Handling Instructions and Addifional Information 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. GENERATOWSIOFFEROR'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 condifion for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I calmly that the contents of this consignment conform to the tens 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(b)(f I am a small quaintly 9 rotor)is true. Generatorsr0geror's PrintediTyped Name Signature Monty Day Year (onlae>�lf of Ub City of Mlvdeca) ��— 3 16.International Shipments F ❑Import N U.S. Export from U.S. Pan of enexit: Transporter signature(for exports only): Date leaving .S.: 17.Transporter now Ackledgment of Receipt of Materials UJI may. Transporter 1 PrintadRypetl Name Signature Monty Day Year a > QTransporter 2 PrintedRyped Name Signator Monty Day Year K r * 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pamal Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone. w 187 Sgnamm of Altemate Faulity(or Generator) Month Day Year zz LD 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O 1' H 1 ,31 3 1 2' 3. 4. 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest excep s noted in Item laa Il Printedfryped Name Signature Monty Day Year S - O 1/ EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILI TO DESTINATION STATE (IF REQUIRED)