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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.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481658 J J K 5.Generator's Name and Mailing Address Generator's Site Address(i different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candmi Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Slmwerman Generators Phone: 6,Transporter 1,eompany NameU.S.EPA ID Number �rPOA417 r -7.? 7.Transporter 2 Company Name U.S.EPA ID Number 8.Desi noted Facility Name and Site Address U.S.EPA ID Number Bu�tonwillOW Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Faciliys Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9s, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Patting Group(i any)) No. Type Quantity Wt Nol. 1, 611 1 DD08 K NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 0 0 1 D T 18 Y z 2. W 3. 4. i 14.Special Handling Instructions and Additional Information Sal: 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 dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and Iabeledlplacanded,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 ced'dy that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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)(i I am a small quantitygenemlor)is true. GeneratofslOfferors PdntedFryped NameSignature y( Month Day Year (on behalf of the City of Manteca) /J\ cv�.+u-aa-a'— 3 'L11 16.International ShipmentsEl F ❑Import to U.S. Export from U.S. Pod of a irylexh: = Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transpode 1 rintedrTyped Name / SignaMe M D ar QTransporter 2 PrntedrTyped Name signill Month Day Year K r I 18.Discrepancy fee.Discrepancy Indication Space El ❑Type 1:1 Residue ❑PaNal Rejection El Pull Rejection Manifest Reference Number 18b.Altemate Facility for Generator) U.S.EPA ID Number J U r� Fadlity'e Phone: W 18c.Signature ofAltemate Facility(or Generator) Month Day Year a z 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 receipt of hazardous materials covered by the manifest except as noted in Item 18a lilt Printedrryped Name Signature Month Day Year 0 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)