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W�98 0 3� y P*ease 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 i of3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481694 J J K 5 Ge erators Name and Mailing Address Generators SM Address(if different than mailing address) 5W ei er Street,Manteca,CA 95337 1077 Milo�dum Drive,Manteca,CA 95337 (209)456-8415 Alin: Greg Showerman Generators Phone: 8.T er 1 Company Name U.S EPA ID Number M4 ��Q09 -22 7.Transpofter 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 Facllitys Phone:(661)762-6200 CAD980675276 go 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Cantairers 11.Total 12,Unit 13 Yyaste Codes HM and Packing Group(if any)) Ne Type Quantity WWoL 1. 611 0 NON-RCRA He—dour Waste,Solids,(Lead) 0 0 1 D T 1 8 Y Liu z. c� I 3 1 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 Egmpmetlt 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 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 dandy Umt the contents of this consignment conform to the terms of the attached EPA Acknoydedgment of Consent. I caNy 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 quantitynemtor)is true. GeneretorsdOfierols PdntedfTyped Name Signature Month Day Year (on behalf of the City of Manteca) 1 16.International Shipments ❑Impod to 0.5. ❑Export him U.S. Port of a /exit Transporter signature(for exports only): Date leat U.S.: Of 17.Tr nsporterAcknowtedgment of Receipt of Materials Xkt Transpo ledfiyped Name Sgnature M nth Day Year O • ' C /V Qr legi 17 Transporter 2 Prin edfryped Name Signa Monty Day Year 1B.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: r 1 Bb.Alternate Faulty(or Generator) U.S.EPA ID Number J v I Facilitys Phone. w 18c.Signature of Alternate Facility for Generator) Month Day Year Q z 19.Hazardous Waste Report Management Medved Codes(i.e.,codes for hazardous vaste treatment,disposal,and recycling systems) o 1 Z 3. 4. !3Z 20.Designated Facility Oymer or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item i8a Printed/Typed Name Signature Month Day Year 140310%-111r- EPA 03 0% 1r- EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)