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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14,Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481689 J J K S.Generators 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 GeneratorsPhone:(209)456-8415 Attn: Greg Showerman 6.Transporter 1 Company Name U.S.EPA ID N mber (D oon/-13aa 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:Phone:( 1)762-6200 CAD 9 8 0 6 7 5 2 7 6 ge 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit 13 Waste Codes HM and Padding Group(if any)) No. Type Quantity WI.Nol. K 1 611 0 NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 DT 18 Y JJ 2. w C) 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 1 2 3 0 7 B Vegetation 0-5% Wear appropriate Personal Protective Equiproent as necessary 15. GENERATOR'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 labeledlpiacarded,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 EPAAcknowledgment of Consent. I cerlHy that the waste minimization statement identified in 40 CFR 261(if I am a large quantity generator)or(b)If I am a small quantity Knadai is We. Generators/Offerors Pdntecirnyped Name Signature Month Day Year (Gn behalf of dW City of Man teCa) -- 2 16.International Shipments ❑Import to U.S. Export from U.S. Port ofbyleidt Transporter signature(for exports onty): Date Wig U.S.: w 17.Transporter Acknowledgment of Receipt of Materials -17 �w Transporter 1 Prinled/nyped Name s Signature Month Day Year 0 / ()12q �• O a 4 Transporter 2 Printed/hyped Name Signature Month Day Year cd s— 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pi Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(a Generator) U.S.EPA ID Number J U 1 Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day tear Q Z CD 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) t 2. 3. 4. 20.Designated Facility Owner or Operator CeNfication of receipt of hazardous materials covered by the manifest except as noted in Item 18a 11 Printed/Typed Name Signature Month Day Year A-- cow 0 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)