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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 7 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 0 9 5 9 9 6 1 1 (800)424-9300 015481692 JJ K 5.Generator's Name and Mailing Address Generators 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 6.Transporter pany Name U.S.EPA ID Number A VEL/ �AL C 7.Transporter 2 Company NamLk 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 C A D 9 8 0 6 7 5 2 7 6 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes 1 No. Type Quantity Wt.Nol. 0 611 NON-RCRA Hazardous Waste, Solids,(Lead) 00 1 D T 1 8 Y Z 2. w I� I 3 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 3 0 7 B Vegetation: 0 -5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'S/OFFEROR'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 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 EPA Acknowledgment of Consent. 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 quantityenerator)is true. Generators/Offeror's Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) -� 16.International Shipments Z) I ►— ❑Import to U.S. ❑Export from U.S. Port of e try/exit: Z Transporter signature(for exports only): - — Date lea g U.S.: LM 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature O - s / Month Day Year Cl) Transporter 2 ted/Typed Name y Signature onth Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number. J U.S.EPA ID Number U Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Q Month Day Year Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 0 1 37— 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed7yped Name Signature Month Day Year � ! EPA Form 8700-22(Rev.3-05) Previous editions are obs03 0�olete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)