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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genemtor ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 0 9 5 9 96 1 (800)424-9300 015481654 J J K <br /> S.Gggerptofsplyge an Mailing Address Generators Site Address(if different than mailing address) <br /> Y1W4 OLW(11 City of Manteca <br /> 1 es er Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 <br /> (209)456-8415 Attn: Greg Showennan <br /> Generator's Phone: <br /> 6.Tr rancher 1 Company N U.S.EPA ID Number <br /> � n 2 �Yv tv�f N�15 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Qesi rated Fq ipy N mow�tl Sjtg-Address U.S.EPA ID Number <br /> 2500 West Lokem Road,Buttonwillow,CA 93206 <br /> FacilBys Phone:(661)762-6200 CAD980675276 <br /> ga 9b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Padding Group(0ani No. Type Quantity Wi <br /> 1 <br /> K <br /> 0 — <br /> NA3077,Hazardous Waste,Solid,N.O.S.,(Lead), 9, PG III 001 D T 18 y <br /> w <br /> W 2 I <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Soil: 95-100% Clean Harbors Profile Number:C H 13 12 3 12 B <br /> Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary <br /> 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, <br /> marked and IabeleNplacanded,and are in all respects in proper condition for transport according to applicable intemationat and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cendy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I ci that the waste minimization statement identified in 40 CFR 261 if I am a large quantity generator)or(b)(HI am a small qu generator)is We. <br /> Generator'slOfferees Printedlfypetl Name (on beSigna Month Day Year <br /> half of the City of Manteca) C AAAe l/ �� 3 I 2 ' <br /> 16.Intemamnal Shipments Import U.S. <br /> F Elpo ❑Expert from U.S. P entry/e>ot: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Matenals <br /> Tran orter 1 Printedfryped NameMonth Day Year <br /> IL <br /> re,..[) 'I .,/y'�-� <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> K <br /> H <br /> 18.Discrepancy <br /> like.Discrepancy Indication Space ❑ Quan <br /> mY ❑T ype 1:1Residue El Partial Rejection Full Rejection <br /> Manifest Reference Number'. <br /> 181b.Alternate Facility(a Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> u Fedlity's Phone: <br /> Qw 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 2 <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4, <br /> 20.Designated Facility Owner or Operator.CeNfication of receipt of hazardous materials covered by the manifest except as noted in Item 1 as <br /> 11I <br /> Printed/Typed Name Signature Month Day Year <br /> r v <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />