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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) D Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 GeneratorID Number 2,Page 1 of T Emergency Response Phone 4.Manlfest Tracking Number WASTE MANIFEST 1 (8QQ)424-9300 015481686 JJ K 5.Gee tots and Mailing Address Genetraytor's Site Address(if different than mailing address) t1J lf Manteca �estCer ter Street,Manteca,CA 95337 X77 Milo Candid Drive,Manteca,CA 95337 ` (209)456-8415 Attn: Greg Showerman Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number f, 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 (661)762-6200 CAD980675276 Facility's Phone: 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./Vol. 1. 611 I NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 DT 18 yLU t w 2. 3. I 4. 1 I 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number:C H 13 1 2 3 0 7 1 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 Intemational and nationa€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 identiried in 40 CFR 262.27(a}(if I am a large quantity generator)or(b)(if I am a small quantity g rator)is true. Generator'slOfferor's PrintedlTyped Name Signature Month Day Year (on behalf of the City of Manteca) 2 ri 1fi.International Shipments ❑Import w U.S. ❑Export from U.S. Port ofirg yfexlt: Transporter signature(for exports only): Date leU.S.: W 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name / Signature Month Day Year CLo 0 zQ Transporter 2 Print yped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type Ll Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: w 18c.Signature of Alternate Facifity(or Generator) Month Day Year CDa z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 7 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba PrintedfTyped Name Signature Month Day Year ol lop 10T—I IL EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)