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Please print or".(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Genes 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 015481675 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 Candini Drive,Manteca,CA 95337 Generators Phone(209)456-8415 Attn: Greg Showemnan 6.Transporter 1 Companyme U.S.EPA ID Number 5 7.Transporter 2 Company arae U.S.EP 10 Number &Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Faciliys Phone(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 ga, 9b.LLS.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(d any)) No. Type Quantity WUNoI. 13,Waste Codes 1. 0 6 1 1 ID008 NA3077,Hazardous Waste, Solid,N.O.S., (Lead),9,PG III 00 1 DT 18 Y w Z 2, JJ co 3 4, I 14.Special Handling Instructions and AddPoonal Information Soil: 95-1000/0 Clean Harbors Profile Number: C H 13 1 2 3 12 B Vegetation 0-5% Wear appropriate Personal Protective Equiprnerrt 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 Iabeledlplacarded,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 caddy 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 generator)or(b)if I am a small quantdy eretor)is true. Generators/Offerors PrintetllTyped Name (on beSigns Nre� Month Day Year half of of M t]ne Citym[eca) 3 I -J 16.International Shipments _ ❑Import N U.S. ❑Export from U.S. Pon of atrylexit: Transporter signature(for exports only): Date lea U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Inintedi Name Signetu 0 D Year a ti Q Transporter riot Name Month Da Ye K y } Ij 16.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type Y El Residue ❑Partial Rejection ❑Full Relectbn Manifest Reference Number: 78b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q LL Fadlirys Phone: w 16c.Signature of Altemate Facility(or Generator) Q Month Day Year Z w19. Managementrdous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p I 2. 3. 4. 1 i3L 20.Designatetl Faality Owner or Operetor Certification of receipt of hazardous materials covered by the manifest except as noted in gem if>a Prime a yped Name Signature Month Day Year EPA Form 9700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)