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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 015481697 JJ K 5.Generators 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 Candirri Drive,Manteca,CA 95337 Generators Phom:(209)456-8415 Attn: Greg Showerman o 6.Transporter i Company Name is �� ✓� ` U.S.ELoe�*Z,9p U 7.Transporter 2 Company Name t/_••• U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttomvillow,CA 93206 Faulitye Phone(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9a gb,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(g any)) No. Type Quantity Wt.Nol. X 611 O _ NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 Y z 2. W W 3, I 4. i 14.Special Handling Instructions and Additional Information Soii: 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 ac urately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,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 certiy 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 26227(a)(if I em a large quantity generator)or(b)(if I am a small quantity nerator)is We. Generators/Offerors Pdntedrryped Name Signature Month Day Year (on behalf of the City of Ma tem) �— 3 Q ...+ 16.International Shipments F ❑Import to U.S. El Export from LLS. Port of an !exit: Transporter signature(for exports only): Dje leavi U.S.: 17.Transporter Acknowledgme l of Receipt of Materials Transporter 1 PdntedlTyped Na Signature Month Day Year yZ IS 7 Q Transporter 2 PrintedRyped Name re Month Day Year C H- } 18.Discrepancy 18a.Discrepancy Indication Space El ❑Type 1:1 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 of Alternate Facility(or Generator) Month Day Year Q Z N19.Haurdous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p t. I -r ^ 2. 3. 4. 1 20.Designated Fadlity Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month DayJYear 03 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FA ILITVT D TINATION STATE (IF REQUIRED)