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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 i of 3.Emergency Response Phone 4.Mantrast Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481698 JJ K 5.Generator,s,,�aa*m��e and Mailing Address Generators Site Address(it drierent than mailing address) rf�l tlVt�"teMer Street,Manteca,CA 95337 City of Manteca 10 Milo Candini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Transporter 1 Company Name U,S.EPA ID Number �L QAA.,vv 2/6 7.Transporter 2 Company Name U.S.EPA ID Number 8,Desinated Facility Name and She Address U.S.EPA ID Number Bui nwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 CAD980675276 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unci 13.Waste Codes HM and Parking Group(it any)) No. Type Quantity WWd. z 611 o — NON-RCRA Hazardous Waste,Solids,(Lead) 00 1 D T 1 8 Y z 2. W f.7 3. 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 Iabeledlplacarded,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 minimisation statement identified in 40 CFR 262.27(a)(M I am a large quantity generator)or(b)(if I am a small quantity en tor)is We. GenemtorslOtterors Pdntedrryped Name SignatureLit Month Day Year (on beW of the City Of Manteca) Q ❑ � 16.International Shipments Import to U.S. Export from U.S. Portalapt Transporter signature(for exports only): Date leavi .5.: w 17.Transporter Acknowledgment of Receipt of Materials t— Transporter 1 Pnntedrryped Na Signature Monty Da Year O K � d QTransporter 2 Printedrfypetl Nam signi Month Day Year 18.Discrepancy 18a.Discrepancy Indication Spaced ❑Full ❑ Quantity —�T;l=� ❑Residue ❑Partial Rejection Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: w 19c.Signature of Alternate Facility(or Generator) Month Day Year Q z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) 2. 3. 4. 20.Designated Fa✓\duty Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PdntWTyped NameI Signature Month Da Year 2411112 ,4 01 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED F CILITY O ESTINATION STATE (IF REOUIR D)