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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.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481690 J J K 5.Generator'sName and Mailing Address Generators Site Address(if different than mailing address) City 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 Showemlan 6.Transported mpany e t LLS PAI tier Gun 7.Transporter ompany Name U.S. 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 CAD980675276 9a 91b.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(it any)) No. Type Quantity Wt Nol. 1 611 0 - NON-RCRA Hazardous Waste,Solids,(Lead) 0 0 1 D T 18 Y z 2. W 3. i 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 12 3 0 7 B Vegetation 0-5% Wear appropriate Personal Protective Egtripmerd as necessary 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are Polly and accurately described above by the proper shipping name,and are classified,packaged, marked and lebeledlplacarded,and are in all respects in proper condition for transport according to applicable international and nabonal governmental regulations.If export shipment and I am the Primary Exporter,I cerlfy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. certfy 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 g erator)is We. GeneratoesrOferors Pnntedfryped Name Signature Monty Day Year (on behalf of the City ofMarltaca) 16.International Shipments F El Import to U.S. Export from U.S. Portotenfexit Transporter signature(for exports only): Date leavin U.S.: 17.Transporter Acknowledgment of Receipt of Materials K Transporter 1 Print yped Name Si Monty Day Year a GTransporter 2 Pnntedlfyped Nam Signature Month Day Year C F ♦ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ouanfity ❑Type ❑Residue ❑Panal Rejection ❑Full Rejection Manifest Reference Number, 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone' W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. I ! 3Z Ill 20.Designated Facility Omer or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item Ilia Printedlryped Name Si nature Month rD�ay Year i (! EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)