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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 i.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 015481656 JJ K 5.Gen@retors Name and Mailing Address Generators Site Address(if different than mailing address) of MaNeca City of Manteca 1 West Center Street,Manteca,CA 95337 1077 Milo Candim Drive,Manteca,CA 95337 (209)456-8415 Attn Greg Showetman Generators Phone: 6.Transporter1 mparMym� U.S.EPA ID Number 7.Transporter 2 Company Name U.S. PA ID Number 8.Desi noted Fa try Name Lan-$fie-Address U.S.EPA ID Number 22500 West Lokern Road,Buttomvillow,CA 93206 (661)762-6200 CAD980675276 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,0 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(I any)) No Type Quantity Wt.Nol. 1. 6 1 1 D008 cc NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 0 0 1 D T 18 Y Ulu 2. W 3. � I 4. i 14.Special Handling Instructions and Additional Information Soil: 95-1000/6 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 antl labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulators.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the tarns of the attached EPAA&novAedgment of Consent. I ceNfy that the waste minimization statement identified in 40 CFR 262.27(a)(l I am a large quaintly generator)or(b)(if I am a small qu 'ty generator)is true. Generators/Offerers Printed/Typed Name Signa Month Day Year (on Uelmif of the city of Marti / 2 1 16.International Shipments F ❑Import to US. ❑Export from U.S. Pof entry/exit: Transporter signature(for exports only): Dat leaving U.S.: W 17.Transporter AcknoWedgment of Receipt of Materials Transporter 1 rintedlTyped Name Signatu Mo a Ve O Cc Q QTransporter 2Prlhtbdrfyped Name S' natur Month Day Year K r } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J E3 LL Facility's Phone: out 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z w19.Hazardous Waste Report Management Method Codes Ile.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 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 Printedrryped Name Signature Month Day Year se-cCA,Llee fi I 0 3 O EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)