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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 MANIFESTUS A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481700 JJ K S.Generetorsame and Mailing Address Generators Site Address(if different than mailing address) T City oManteca City of Manteca 1001 West Center Street,Manteca, CA 95337 1077 Milo Candim Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Transporter 1 Company Name U.S EPA ID Number r, (,Aoo3 4 7.T s Rel2 Comps lame U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttormllow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 (661) 762-6200 CAD980675276 Faality's Phone' ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 13.Containers 11.Total 12.Unit HM and Packing Group(f any)) No. Type Quantity Wtivol. 13.Waste Codes 1. 611 fY O NON-RCRA Ham dour Waste, Solids,(Lead) 0 0 1 D T 18 y ILIA 2 w f9 3. 4, 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 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 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 tam 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 quji generator)is true. GenerstorslOfemrs Printed/Typed NameSignature Month Day Year (onbellelfoftheCityofMaotaca) CAA �' 3 2 1 16.International Shipments F ❑Import m U.S. Fort from U.S. PORntrylexh: Transporter sgnature(for exports only): Dateliving U.S.: a 17.Transporter Acknowledgment of Receipt of Materials LIJ R Tre ^Printedrryped Name Sig Mon Day Year 0- Ste,! t�c� ,``✓yam( 2 Transporter 2 Printedryped Signature Month Day Year Q C F 18.Discrepancy 188.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑full Rejection Manifest Reference Number. 181b.Altemam Facility(or Generator) U.S.EPA ID Number J U I Facilitys Phone: w 1So.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) 0 1. �Z � 2. 3. a. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item far Printedrryped Name1 Signature Month Day Year It/t` o EPA Form 8700-22(Rev. 5) Previous editions are obsolete. DESIGNATEt FACILIV DESTINATION STATE (IF REQUIRED)