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Please print or e. Form designed for use on elite 12 itch typewriter.) y�— 6 r Form Approved.OMB No.2050-0039 P type.( 9 ( P ) YP ) PP 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number UNIFORM MAS WASTE MANIFESTNIFESTC A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015 481677 JJ K 5.Generator's 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.Transporter 1 C pony Nam U.S.EPA ID umber ))Z2 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 CAD 980675276 ga 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 D008 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 00 1 DT 1 8 Y z 2. w c� 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 12 3 12 B Vegetation: 0 -5% Wear appropriate Personal Protective Equipment as necessary 15. GEN ERATOR'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 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 quanti enerator)is true. GeneratorVOfferor's Printed[Typed Name Signature Month Day Year (on behalf of the City of Manteca) 3 Q —J 116.International Shipments _ Import to U.S. Export from U.S. Pot entry/exit: F-- E] Z Transporter signature(for exports only): Date I aving U.S.: rx 17.Transporter Acknowledgment of Receipt of Materials Transporter 1nted Tyf ped Name Signat r Mont Day Year d rnMonth Da Year z Transporter 2 Printed yped Name Signature y Q � F- H 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 Facility's Phone: W18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. I�2 2. 3, 4. 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year An (4� Lcs 0"7 *"N - 1 03 1[,� I EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FA LITY TO DE TINATION STATE (IF REQUIRED)