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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 C A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481671 JJ K 5 Generators 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 Generator's Phone:(209)456-8415 Attn: Greg Showerman 6.Transporter1 C mpan me Ice//)�/ U.S.EPA ID Number OLGC \ I'L©0(f) 7 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone:(661)762 -6200 C A D 9 8 0 6 7 5 2 7 6 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.IVol. 1. 611 D008 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9, PG III 00 1 D T 18 1' w Z 2 0 3. 4. 14.Special Handling Instructions and Additional Information _Sail: 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 quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year (an behalf of the City of Manteca) 3 2 � —u 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port entry/exit: Transporter signature(for exports only): — Date I aving U.S.: LW IT Transporter Acknowledgment of Receipt of Materials L X Transpo ter�rinted yped Name m Signature 0 1 ' ' �� / Moa �� Year a Q Transporter 2 P17 rintedlryped Name Sign re Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) J U.S.EPA ID Number U LL Facility's Phone: Lu 18c.Signature of Alternate Facility(or Generator) Q Month Day Year z 19.Hazardo Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 7 2. 3. J 4. 20.Designated Facility or Operator:Certification of receipt of haz ous materials covered by the manifest except as noted in Item 18a Printed(fyped Na Signature A/� Mon D Year EPA Form 8700-22(Rev.3-05) Pr/ev(i�ous editions ar solete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)