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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 015481696 JJK_ 5.Generator's Name and Mailing Address Generraattor's Site Address(if different than mailing address) Yca 6'loV erWer Street,Manteca,CA 95337 1077 fMiillo MaCandini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generator's Phone: 6.Transporter 1 Co pang Name U.S.EPA ID Number � e2- r oa ZZ �?C/ 7.Transporter 2 Company Name CZ U.S.EPA ID Number 8. esi Hated Fa ity Name and Site Address U.S.EPA ID Number �u�tonwr�ow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 (661)762 -6200 C A D 9 8 0 6 7 5 2 7 6 Facility's Phone: ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. 611 O NON-RCRA Hazardous Waste, Solids,(Lead) 00 1 D T 1 8 Y z 2. w c7 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'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 1 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 quantity nerator)is true. Generator's/Offeror's Printed(Typed Name Signature Month Day Year (on behalf of the City of Manteca) 2 16.International Shipments 11- ❑Import to U.S. El Export from U.S. Port of e t y/exit: Z Transporter signature(for exports only): Date lea g U.S.: LW 17.Transporter Acknowledgment of Receipt of Materials LW ranspornow Transporter Printed(Typ Name` � ^ Signature Month Day Year a C/_v tp/L(—J C QTransporter 2 Pr nted Typed Name Signature Month Day Year W t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type1 ElResidue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U tai Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1, 4 `^ ^ 2. 3. 4. 20.Designated Facility— or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year ARIA Al,11-5S, 0r-11 Z J1LI 03 0�- 1 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNAT,EqFACILI1kYJ0 DESTINATION STATE (IF REQUIRED)