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Please print or type.(Foram designed for use on elite(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 CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481680 JJK 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 Company Na e U.S.EPA IV I �a rQ 7.Transporter 2 Company Name U.S.EPAID 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:(66 1)762-6200 CAD 9 8 0 6 7 5 2 7 6 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. 611 NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 1C z 2. LU r 3. m i 4 c , � k 14.Special Handling Instructions and Addifional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 1 2 3 0 7 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'$IOFFEROR'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 labeledlp€acarded,and are in all respects in proper condition for transport according to applicable international and national governmentai 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 EPAAcknowiedgment 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 l am a small quantity ge tor}is true. Generator's/Offerors Printed/Typed NameSignature Month Day Year (on behalf of the City of Ma�eca} :. 16.International Shipments Import to U.S. Export from U.S. Port of ent exit H ❑ Z Transporter signature(for exports only): pate leavin U.S.: w 17.TransporlerAcknowledgment of Receipt of Materials 12 Transporter 1 P' yped NameSigna _ Month Day Year c [ Q Transporter 2 Printedrryped Nae Signature II Day Year H 18.Discrepancy 18a,Discrepancy Indication Space Quanti ❑Type ty yp ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U ta+ Facility's Phone: Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 13Z 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be Printed/Typed Name Signature Month Day Year J EPA Farm 8700-22(Rev.3-05) Previous Bions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) �p