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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 C A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481699 JJ K 5.Generator's 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 Candini Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Showerman 6 Transporter 1 omp am U.S.EPA ID Number 7 Transporter 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 Facility's Phone:(661)762-6200 C A D 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 HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity WtNol. W 1 611 O NON-RCRA Hazardous Waste, Solids,(Lead) 00 1 DT 18 Y w w 2 / C9 , 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. GEN ERATOR'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 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. Generators/Offerors Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) S 2 J 16.International Shipments z ❑Import to U.S. ❑Export from U.S. Port of ntry/exit Transporter signature(for exports only): Date le ing U.S.: 17.Transporter Acknowledgment of Receipt of Materials Lu Transporter 1 Printed(fyped Name Signatur Month Dai Year L Nfo rd �/ ° l Z Trans 2 P intedffyped Name Sig u Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space El Quantity 11 Type ❑Residue ❑Partial Rejection ❑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.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) p 1. 'n -z_ 2, 3. 4. 20.Designated FacilityOwnerOwner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed NameI A Signature Menth D e AQ EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FA ILITY T Q STINATION STATE (IF REQUIR D)