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3� `fir X13/ 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.Eme ency Res rise Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (8d0)429300 015481673 JJ K 5.Generators Name and Mailing Address Generators Site Address if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candurt Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Showerman 6.Trans Compan ame U. .EPA ID Number ''7 U l 7.Transpo erg Compaq Name U.S.EPA ID Number 8.Designated Facility Name and She Address U.S.EPA ID Number Buttormillow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Facility's Phone 661)762-6200 CAD 9 8 0 6 7 5 2 7 6 gra 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 6 11 D008 . NA3077,Ha2ardous Waste, Solid,N.O.S.,(Lead),9,PG III 00 1 D T 18 S' i 2. W 3. 4. 14.Special Handling Instructions and Additional Information Sal. 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 Iabeledlplararded,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 centy But the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. I cem 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, GeneratoesrOHemes Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) 3 —1116.International Shipments i ElImport to U.S. ❑Export from U.S. Pod o ntrylexif Transporter signature(for exports only): Date le ting U.S.: W 17.Tr99po1jr Acknowledgment of Receipt of Materials Tra po r Pdnte ped Name Si atur Mo91h Oay Yeer a ?V l !/ N Q Transporter PrintedRyp Name Signature Month Day YMar K r I18.Discrepancy 18a.Discrepancy Indication Space El ❑Type 1:1 Residue ElPaNaI Rejecton ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U u<. Facility's Phone. w 18c.Signature of Altemate Facility(or Generator) Month Day Year Q 2 H19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 20.Desisgn1ated Faality Owner cr Operator Cerm ion of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed?yped Name Signature Month Day Year 1 DIS- 01 UM 111 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATE131F t ILITYftDTl NATION STATE(IF REQUIP1D)