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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 one 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481661 JJ K 5.Generators 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 Generators Phone:(209) 456-8415 Attn: Greg Showerman 6.Transporter 1 Company Name U.S.EPA ID Number d,, 4o ,i " - -fe'to?5 a 3 & 7 7 Transporter 2 Company Namf U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone: (661) 762-6200 CA 980675276 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 2,Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. 61 1 D008 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 00 1 D T 1 8 y z 2. Lu c� 3. 4. i I 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 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 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 conform to the terms 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)(if I am a small quanti enerator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) , /Q -�s Q —J 116.International Shipments ❑Import to U.S. Export from U.S. Pot f entry/exit: Transporter signature(for exports only): Datelaving U.S.: L 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedff N e Signatur 7 r Month Day `Year �/ �7�1e N Month Da ear Z Transporter 2 r ed(Typed Name Signatur y Q 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U Lt Facility's Phone: U0 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 2. 3. 4. - - 1/3Z 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year Printed Typed Name Signature s�✓c EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)