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Please print or type.(Form designed for use on eine(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 I CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481679 JJ K 5.Generator's 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,Sbowerman 6.Transporter 1 Company Name U.S.EPA ID Number 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 980675276 9a. 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 W#.Nol. 1. 6 I 1 NON-RCRA Hazardous Waste,Solid,(Lead) 0 0 1 DT 118 Z 2. LU � I s 3. 4. tow ( t 14.Special Handling instructions and Additional information Soli: 95-100% Clean Harbors Profile Number: C H 13 12 3 0 7 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 international and natlonah governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform 10 the terms of the attached EPAAcknowledgmert of Consent. I certify that the waste minimization statement identified in 40 GFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity g erator)is true. Generator"sl01erors PrintedlTyped Name Signature Month Day Year (onbehalf of the City of Manteca) J 16.International Shipments I- Import to U.S. ❑Export from US. Part of on Iexit: Transporter signature(for exports only): Date leavi U.S.: w 17.Transporter Acknowledgment of Receipt of Materials O Transporter 1 PrintedTr ddgName 1kSignature Month Day Year ca zQ Transporter 2 PrintedfTyped Name Signature Month Day Yetr H 18.Discrepancy 18a,Discrepancy Indication Space ❑ QuantityTypo Residue ❑Full Rejection ❑T ❑ ❑Partial Re'ection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J - V Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes 0-e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 0 1. 2. 3. 4. ,3Z 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 r. yl9 �-l- o EPA'i 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)