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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.GeneratorID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 1015481668 J J K 5.Ge emtors a and Mailing Address Generators Site Address(l different than mailing address) Ge oblanteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attrc(keg Showecman 6.Transporter 1 Company Name U.S.EPA ID Number pl c) 014gra 0 0 1-1 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttormillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone:(661)762 -6200 CAD980675276 ga, 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(Reny)) No. Type DueMRy WtNol. 1 D008 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG 111 00 1 D T 18 5' z 2. W c7 3. 4, 14,Special Handling Instructions and Additional Information Soil: 95-100% 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 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 coni for transport according to applicable imemaoonal and national governmental regulations.R export shipment and I am the Primary Exporter,I cen'dy 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 261(if I am a large quantity generator)or(b)(RI am a small quantity generator)is true. GeneratorsrORerors Printedrryped Name Signature Month Day year (onbehelf of the City of Mtul[eca) � J 16.International Shipments F— ❑Import to U.S. ❑Export from U.S. Pon of an 1i = Transporter nature fore its W s5 ( exports only): Date kavi S.: W17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedrryped Name Signa um Month Day Veer QTransporter 2 PdntedrTyped Name Signature Month /Day Ye5r K H 1 16.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Penial Rejection Elul Rejection Manifest Reference Number: 18b.Altamaha Facility(or Generator) U.S.EPA ID Number J 6.1 LL Facility's Phone. W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q 2 h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O 1' 4. 1 20.Designated Fadl Owner or Operator.Certification M receipt of hazardous materials covered by the manifest except as nded in them 18a Printedrryped Name Signature Month Dav Year 3 D EPA Form 8700-22(Rev.3 -05) Previouseditionsare obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)