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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 IO 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 015481660 J J K 5 G eratols a and Mailing Address General Sim Address(if different than mailing address) �itv ot" anteca City of Manteca 1001 West Center Strut,Mardeca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Trail Cam ame h/V J` U.S.EPA ION u�� 4 J 7.Transpoll I Company Name � 7 U.S.EPA ID Number W 8.iesi noted Fa d Sjt9 Address I U.S.EPA ID Number 2500 West Lokem Road,Bultonwillow,CA 93206 (661)762-6200 CAD980675276 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Haul Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Qua" Wl t l O NA3077,Hawdous Waste,Solid,N.O.S.,(Lead),9,PG III 00 1 D T 1 8 1 Z 2, w c7 3. • 4 14.Special Handling Instructions and Additional Information ZKZ� Soil: 95-100% Clean Harbors Profile Number: C H 13 12 3 12 B Vegetation 0-5% Wear appropriate Personal Protective EtImptment as necessal 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 and labeled/placarded,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 certify that the contents of this consignment oxtlonn to the terms of the affadied 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)(if I am a small qu tity generator)Is true. GeneratolslOBemis Printecirryped Name Signature Month Day Year (onbehelf of the City of Manteca) 16.International Shipments ❑Import to U.S. ❑Export from U.S. Po f entry/exit M Transporter signature(for exports only): Da Angus CC 17.Transporter Acknowledgment of Receipt of Materials � Tran 1 Prin yped Name Signature Month Year O z Transporter 2 Printed7Typed Name Signature Month Day Year Q K H 18.Discrepancy 19a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Mandest Reference Number. 19b.A-3ei to Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: w 1Be.Signature of Alternate Facility(or Generator) Month Day Year a z as 19.Hazardous Waste Report Management Method Codas(i.e.,codes for hazardous waste treatment,disposal,and reading systems) D 1' 2. 3. 4. l 13Z 20.Designated Fadlify&ner or Operator.Certification o(receipt of halloos materials ceveretl by the manifest except as noted in Item 18a Printed/Typed Name Signature Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)