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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.Genemtor 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 015481672 J J K 5 G��ww tots an Mailing Address Generators Site Address(if different than mailing address) 7 ler Street,Manteca,CA 95337 I077 W Candw Drive,Manteca,CA 95337 (209)456-8415 Attn:Greg Showefman Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 1 7.Transporter 2 ompa Name U.S.EPA Number 8. esi mated Fq ity Name and Site Address U.S.EPA ID Number U ow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 ga 9b.US.DOT Description(including Proper Shipping Name,Hazard Class,l0 Number, 10.Containers 11.Total r12.Umt 13.Waste Codes HMand Packing Group If any)) No. Type Quantity K1 1D008 NA3077,Hazetrious Waste Slid N.O.S.,(Lead),9,PG III 0 0 1 D T 1 8 z 2. w 0 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'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 labeled/placarded and are in all respects in proper condition for transport according to applicable intemational 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 rertlty 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. Generators/0lferor's Pnntecirryped Name (on belialfofft City ofMar"ca) Signature Month Day Year J 16.International Shipments i ❑Import to U'S ❑Export from U.S. Po of entrylexe: Transporter signature(for exports only): oat leaving U.S.: w 17.TmnsponerAcknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Name Signa a Month Day Year N a n 10 I Z Tra sporter 2 Pnnted?yped Name Signature Month Day Y ar It It F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone. W 18c.Signature of A temate Facility(or Generator) Month Day Year ZZ H19.Hazardous Waste Report Management Method Codes(i.e-codes for hazardous waste treatment,disposal,and recycling systems) 20.Designated Facilityer Operator Certification of receipt of hazy s materials covered by the manifest except as noted in Item 1 Be Pnntedllypad Name Signature Mon Dfly Year /� (/ EPA Form 8700- (Rev.3-05) Previouseditionsaeoidlete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)