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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Farm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 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 1015481693 J J K 5.Generators Name and Mailing Address Generatces 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 Atte: Greg Showerman 6.Transporter i mea Name U.S.EPA ID Number I v� o� 7 Transportr 2 Company Name U.S. PAIDNumber 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokem Road.,Buttonwillow,CA 93206 Facility's Phone.(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9a. 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 Wt.Nol. 1. 611 O 9 NON-RCRA Haxerdous Waste,Solids,(Lead) 0 0 1 D T 18 Y W w Z. W 0 3. 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 Equipment 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 labeledlplaurded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the tens 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 quanti enerator)is true. Genaratoes'Offerors Pnntetllfyped Name Signature Month Day Year (on behalf of the City ofMarteca) 16.International Shipments � ❑Impod to U.S. ❑Export from U.S. Ponf entrylexif. Transporter signature(for exports only): Date avitg U.S.. w 17.Transporter AcknoWedgmentof Recoiptof Matedals Tran r 1 PnntedlTyped Name Signature Month Year N IBJ 1J 7 za I ranSikirter 2 Pnnted7fypetl Name Signator Month Day Y ar C F 18.i Discrepancy 18a.Discrepancy Indication Space El 1:1 Type ❑Residue ElPartialRejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q H0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous"are treatment,disposal,and recycling systems) 1 p . 2. 3. 4. 1 , 3Z 20.Designated Facility Owner or Operator:Certification of receipt of haurdous marenals covered by the manifest except as mdse in Item 18a Pnntedfryped Name Signature Month Day Year 03 1 O EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)