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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?racking Number WASTE MANIFEST CAL000095996 1 (800)424-9300 015481670 JJK 5.Gegerator's r an Mailing Address Generators Site Address(if different than mailing address) 11 JUxOy ca City of Manteca 1 est enter Street,Manteca, CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 1°D S 6 7 Transporter Company Name U.S.EPAI Number 8 Desi nated Facility Name and Site Address U.S.EPA ID Number Bu�tonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 (661)762-6200 C A D 9 8 0 6 7 5 2 7 6 Facility's Phone: 9a 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(if any)) No. Type Quantity Wt.Nol. 1. 61 1 D008O 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 0 0 1 DT 1 8 Y z 2. LU c� 3. 4. 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'S/OFFEROR'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 quan'ty generator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) U C-AA /l —J 116.International Shipments ❑Import to U.S. Export from U.S. Portf entry/exit: z Transporter signature(for exports only): Date aving U.S.: w 17 Transporter Acknowledgment of Receipt of Materials U Transporter 1 Printed/Typed Name Signature Month Day Year O — a �n M Transp—ofter 2 PQ5011rtyped Name Signature Month Day Year Q rY t- 18.Discrepancy � I 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection u Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: Lo 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z O N 19 Hazardou Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. � 2. 3. 4. 20.Designated Facility ner Operator:Certification of re pt of haza ous materials covered by the manifest except as noted in Item 18a Printed/Typed IN % _Signature14 4� ear EPA Form 8700-22(Rev.3-05) Previous editions are o olete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)