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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 lD Number 2.Pagelof 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481664 J J K 5 Gngqmtors me and Mailing Address Generators Site Address,(if different than mailing address) l:l oI Manteca City tY (Y of Mantra 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Showerman ' 6.Transporter l Company ma 1-1,1111mbar fIC 7.Transporter 2 Company Name U.S.EPA 10 Num 8.Desi naiad Fadlity Name and Site Address U.S.EPA ID Number Bu�tomgillow Landfill 2500 West Lokem Road,Buttornwillow,CA 93206 Facilitys Phone:(661)762-6200 CAD980675276 ge 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group)d any)) 13.Waste Codes No. type Quantity WI.NoI. 1. K O NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG 111 00 1 D T 18 Y z 2. W 3. 4. 14.Special Handling Instructions and Additional Information Sal: 95-100°/a 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"tents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intematlonal 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 quantlty generator)or(b)(BI am a small quantity generator)is true. GenemtorsMerofs Printed/Typed NameSignature Montle Day Year (onbehaitofthe City ofMaaeca) cL UkLAAd� 2 ' i6.International Shipments _ E]Import to U.S. ❑Export from U.S. Porto entry/exit: Trensporter signature(far exports only): Date I virg U.S.: W 17.Transporter Acknowledgment of Receipt of Materia W Transporter 1 Name Sign �f Year O H Q Tansporter,2 Printed/Typed Name Month De Year K y r } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ouam ity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) Manifest EPA ID Number J U LL Facilltys Phone: w 18c.SignawmofAltemaie Faality(or Geneator) Month Day Year Q Z y19.Hammes Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1. 2. 3. 4. 1 � � � 20.Designated Facility Owner or Operator Certification of receipt of hazartlous materials covered by the manifest except as noted in Item 18a Printe0yped Name Signature Month Day Year 10-31 04 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)