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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 015481665 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candim Drive,Manteca,CA 95337 Generators Phone(209)456-8415 Atte: Greg Showerman 6.Transporter 1 Company Name U.S.EPA ID Number I}W 0 6ZS3S 7.Transporter 2 Company Name U. . PA ID Number 8.Designated Facility Name and SRe Address U.S.EPA ID Number Buttortili Landfill 2500 West Lokem.Road,Buttonwillow,CA 93206 Faaf s Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 ge_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12 Unit 13 Waste Codes HM and Packing Group(it any)) No. Type Quantity WLNoI. 1. 6 1 1 D008 O NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG 1II 00 1 D T 18 S' w z 2. W (9 3. 4. i 14.Special Handling Instructions and Additional Information Soil: 95-1000/a Clean Harbors Profile Number: C H 13 12 3 12 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the pmper shipping name,and are classified,packaged, marked and labeledlplacerded,and are in all respects in proper condition for transport according 0 applicable intematonal and national governmental regulations.If export shipment and I am th Primary Exporter,I certify that the contents of this consignment conform to the terms of the adached 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 quamixgeneraton is true, GerieratorslOBerors PdntedrTyped Name Signature Month Day Year (on behalf of the City ofMlaYeca) ... . �_ � � ' j 16.International Shipments r— ❑Import to U.S. ❑Export horn U.S. Port o ntry/exit: Transporter signature(for exports only): Date Ie ving U.S.: W 17.Transporter Admowledgment of Receipt of Materials K Transporter 1 Printed/Typed Name Signature Month Da year O y a M Transpo 2 Prin yped Name Q Signature Month Day Year K 4. 18.Discrepancy 18a.Discrepancy Indication Space ❑ n(humbly ❑Type El Residue ❑Partici Rejection ❑Full Rejection Manifest Reference Number: i8b.ARemate Facility(or Generator) � U.S.EPA ID Number U Faaldy's Phone. Maj 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z H19.Hi ramous Waste Report Management Method Codes(i.e.,codes for himardous waste treatment,disposal,and recycling systems) D I' 20.Designated Faal'dy Ormer or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Rem laa 11I Printedrryped Name Signature MonthDaY year G r/ l EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)