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Please print or".(Form designed for use on elle(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 015481669 J J K 5.Genemlors 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 Co try Nahof U.S.EPA i Number i 7.Transporter 2 Company Nellie U.S.EPMIU Num ter 8.Designated Facility Name and Site Address U.S.EPA IO Number Btdtonwillow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Facilitis Phone:(661)762 -6200 CAD 9 8 0 6 7 5 2 7 6 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hasty Class,ID Number, 10.Containers 11.Total Q.Unit 13.Waste Cordes HM and Packing Group(d anY)) TDTT Quantity Wt.Nol. 6 11 D008 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 0 18 S' i 2. w 3. 4, 14.Special Handling Instructions and Additional hrfonnation Sail: 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 accumtely 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 minimisation statement identified in 40 CFR 262.27(a)if I am a large quantity genal&)or(b)(if I am a small quantity generator)is true. Geneators/Offerors Printed7ryped Name Signature p� Monty Day Year (on be]mlfofUlaCity ofMar[eca) /`\t 3 I2 16.International Shipments f ❑Import to U.S. Export from U.S. Pon of /exit Z Transporter signature(for exports only): Date leav g U.S.: K 17.TansporterAcknowledgmentof Receiptof Materials Lau Transporter 1 Pnnred7Typed Name Si gnature Month Day Year O f6n I Month Da Year zz Ta der 2 Printed(ryped Name Signature Y K H } 1B.Discrepancy fee.Discrepancy Indication Space ElQuaintlyElType ❑Residue Ll Partial Resection El Full RejecOon Manifest Reference Number 18b.Alternate Facility for Generator) U.S.EPA ID Number J_ V LL Facility's Phone: W 18c.Signature ofAtemate Facility(or Generator) Month Day Year a Z H19.Hazardous asta Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) 1 /J a 2, 3� 4. 20.Designated Faciltytor:Certification of receipt of hese ts materials covered by the manifest except as noted in Item 1a Pdnted/Typed Name Q i SigneNre Mon ay Year EPA Form 8700.22(Rev.3-05) Previous editions are c solate. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)