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` <br /> Please print or (Form <br /> type. designed for use on elite Of24 ' ewriter.) UU p 1 <br /> UNIFORM HAZARDOUS 1 Generator ID Number <br /> WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 2,Page 1 of 3.Emergency Response phone Form Approved.OMB No.2050-0039 <br /> 5.Generators Name and Mailing Address (800)424-9300 �•INanrfest Traacking Number <br /> City Of Manteca Generator's Site Address(if different than maifing01548168 <br /> 1ss) 4 81 6 8 Z JJ K <br /> 1001 West Center Stt Manteca, CA 95337 of Manteca <br /> Generator's Phone:(209)456-8415 Attn.- 1077 Milo Candini DF1Ve,lyZant c�CA 95337 <br /> 6.Traps� any ompName 9 Show <br /> r <br /> 7.Transporter 2 Comp Na a U.S,EPA ID Number <br /> 1Z- 0 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Butbnwillow Landfill <br /> 2500 West Loleern Road,Buttonwillow,CA 93206 U.S.EPA ID Number <br /> Facility's Ph°ne:(61)762-6200 <br /> 9a. 9b.U,S,DOT Description(including Proper Shipping Name,Hazard Class,iD Number, CAD 9 8 0 6 7 5 2 7 6 <br /> HM and Packing Group(if any)) 10.Containers <br /> 1. 91.Total 12.Unit <br /> p No. Type Quantity Wt./Vol. 13.Waste Codes <br /> NON-RCRA Hazardous Waste, Solids,(Lead) 61 1 ,' <br /> LU <br /> Z 2, 0 0 1 D T 18 y <br /> r <br /> i <br /> c <br /> I � <br /> 4. <br /> ) <br /> 94,Special Handling Instructions <br /> ) <br /> Soil; 95-1000% Clean Harbors Profile Number: C H 1 31 2 3 0 7 B <br /> Vegetation:0-5% Wear appropriate Personal Protective E <br /> necessary <br /> 15. GE ked and R'SIOFFlacard d Cnd are C all res thereby declare th111 at the contents of this consignment are fulrnly anted Ricci 11 d s ''b" a t,y me proper shipping name,and are classified <br /> Marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental L Pro lions,If export shipment and f am the prima <br /> Exporter,I certify that the contents of this consignment conform to the forms of the attached EPA Acknowledgment of Consent packaged, <br /> ry <br /> I certify that the waste minimization statement identr{ed in q0 CFR he ter{a)(if I e a a quantity large <br /> Generator'slOffemrs PrintedlTyped Name <br /> 9 4 ty generator)or(b)(IFI am a small quantity generator)is true. <br /> (on beh1f of the City of M�caSignature <br /> 16.International ShiMonth Day <br /> Year <br /> ~ ❑import to U.S. 3 <br /> Z Transporter signature(for exports only): ❑Export from U.S. <br /> Portof ent xit: <br /> ,U 17.Transporter Acknowledgment of Receipt of Materials Date leavin U.S.: <br /> Transporter 1 Printedl7 ed Name <br /> a Signature <br /> QTran sporter 2Pdn yped Name ('C r Month Day Y, <br /> F Signature <br /> th Day ear <br /> 18.Discrepancy <br /> 180.Discrepancy Indication Space <br /> ❑ Quantity ❑Type <br /> ❑Residue ❑Partial Rejection <br /> ❑Ful!Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> a <br /> j U.S.EPA ID Number <br /> Facility's Phone: <br /> lac.Signature of Alternate Facility(or Generator) <br /> [ Month Day Year <br /> 19.hazardous Waste Report Management Method Codes(i.e.,caries for hazardous waste treatment disposal,and recycling systems) <br /> u 2. 3 4. <br /> 20,Designated Facility Owner or Operator.Certification of—c ipi of hazardous materials covered by the manifest Purexcept as noted in Item 180 Month oay Year <br /> PrintedfTyped Name <br /> .PA Form 8700.22(Rev.3-05) Previous editions are obsolete. [3ESICaNATED FACILITY TO DESTINATION STATE(!F REQUIRED) <br />