FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB Na.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000095996 l 015481687 JJK 5.Generator's Name and Mailing Address Generator's Site Address(if ci ferent than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 9.5337 Generators Phone:(209)456-8415 Atil l:Greg Showeiman 6.Transporter 1 Company Name U.S.EPA ID Number 0 ' ® . 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 CA 980675276 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 Wit./Vol. 1, 611 NON-RCP A Hazardous Waste, Solids,(Lead) 0 0 1 DT 18 Y W 2. I I ; r i 4, 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 Personal Protective Egiripment 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 labeledlplacarded,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 4' Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. r 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 quanti enerator)is true. Generator'slOfferor's PrintedlTyped Name Signature Month Day Year (on behalf of the Gill of Mmlteca) '1�3 2 j ri 16.Intematioral Shipments F ❑Import to U.S. ❑Export from U.S. Port ofiryfexit: ? Transporter signature(for exports only). Date lea ing U.S.. w17.Transporter AcknowledgmA of Receipt of Materials Transporter 1 PrintedlType ame Signature Month Day Year 0 rorter 2 PrinteVyped Name Signatu Mol Day Year I- 18.Discrepancy af: 18a.Discrepancy Indication Space ElQuantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility{or Generator) U.S.EPA ID Number V y' LL Facility's Phone: Month Day Year W 18c.Signature of Alternate Facility(or Generator) a z ,(R 19.Hazardous Vbste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2, 3. 4. 20.Designated Facility Own r emttoor�:Certification of receipt of h zardous te' covered by the manifest except as noted in Item 184 Printed/Typed Name L� 'r � � Signature Day Ye r EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)