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y Please ior type.{Form designed for use on elite(12-1typewriter.) Form Approved.01VI8 No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone anifest Tracking Number WASTE MANIFEST CAL 0 0 0 4 9 5 9 9 6 1 (800)424-9300 r015481685 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 Showerman 6.Transporter 1 Cc ny Name U.S.EPA ID Number 7.Transporter 2 Com y Name U.S.EPA kD 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:(66l)762-6200 CAD 9 8 0 675276 9a 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 WtJV01. 1. 611 ------------- NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 Y Z 2.LU r 3. r a. r i ( r 4. i 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 12 3 0 7 B Vegetation 0-5% Wear appropriate Persmal Protective Equipment as necessary 15. GENERATOR'S10FFEROR'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 quantity erator)is true. rtor'slofferors PrintedlTyped Name Signature Month Day Year ii behalf of the City of Marleca) L-I�a-�-- t 16.International Shipments ❑import to U.S. ❑ p try Z p Export from U.S. Port of ing !exit: Transporter signature(for exports only): Date leU.S.: W 17.TransporterAcknowledgmert of Receipt of Materials Transporter 1 Printed/Typed NameSignatu Month Day Year O CL a a Transporter 2 Pri lTyp d Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑TypeI j Residue Partial Re'ecii0n Full Rejection Manifest Reference Number: 16b.Alternate Facility(or Generator) U.S.EPA ID Number U LL. Facility's Phone: ' w 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. ! / 37- 20.Designated Faciiity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 16a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) k