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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) " [r)4C ill Farm 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 015481691 JJ K 5.Generator's 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 Generators Phone:(209)456-8415 Attn: Greg Showerman Or 6.Transporter 1 Company Name U.S.EPA ID Number 6 7.Tr nsporter Cmpa ony erne U. . PA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttorrvvillow Landfill 2500 West Lokem Road,Buttorrvvillow,CA 93206 Facilitys Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9a 9b.U.S.DOT Desorption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packng Group if ani --No Type Quantity Wt.N01. 13.Waste Codes z 1 611 NON-RCRA Hazardous Waste,Solids,(Lead) 0 0 1 D T 18 S' w Z 2. W (9 3. i 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 Equipment as necessary 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare 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 mildly,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)(81 am a large quantity generator)or(b)(if I am a small qu tty generator)is We. Generators/OBemes Printed7Typed Name of the(on beSgnatum Month Day Year half City of Mmaeca) CAA. �-Ia lJ2�� Z 2 I � 76.International Shipments z ❑Import to U.S. ❑upon from U.S. Po of entrylexit: Transporter signature(for exports only): Da leaving U.S.'. W 17.Transporter Acknowledgment of Receipt of Materials O Transporter 1 Pdnted7Typed Name Si nature 9 Month Da Year a Q ' % z Transporter 2 Pent d Name Si nature g Month Day Year 18.Discrepancy Its.Discrepancy Indication Space ❑ Quart tdY ❑Type El Residue ❑Pamal Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) � U.S.EPA ID Number U LL Facilitys Phone: W 18c.Signature of Aftemate Faciliy(or Generator) F Monts Day Year Z Z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O t' I I 1 e� -L 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manpest except as nded in be laa - Printed/Typed Name �1- Signature Month ODay Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. fir/// DESIGNATED FA ILITY O ESTINATION STATE(IF REQUIRED)