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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 I CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481701 J J K 5.Generators Name and Mailing Address Generators Site Address(f diferent than mailing address) City of Mardeca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Sbowerman 6.Transporter 1 Company Name U.S.EPA ID Number 2 Z 7.Transporter 2 Company Name U. .EPA ID Number 8,Designated Facility Name and Site Address U.S.EPA ID Number Buttorfwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 1 CAD 9 8 0 6 7 5 2 7 6 gat 9b.U.S.DOT Desorption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 1 12.Unit 13.Waste Codes HM and Packing Croup(itany)) No. Type Quantity wi 1. 611 C O NON-RCRA Ha7rdors Waste,Solids,(Lead) 0 0 1 D T 18 1 z 2. W 3. 4. 14.Special Handling Instructions and Additional Information Sal: 95-1000/a 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,Dackaged. marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and nalonal governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the tens of the afaclred 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 qua generator)is We. GeneratoeslOferors Pmdedlryped Name Signatura Month Dry Year (on behalf of the City of IMitmteca) tfi.International Shipments ❑Import to U.S. Export from U.S. Port entrylexit: = Transporter signature(for exports only): Date .ng U.S.: K 17.TransporterAduwwledgment of Receipt of Materials Transporter 1 PnntedRyW Na Sign to Monty Day /Y)ear Q 1 (L ransponer`2 PnnWM3W Name Signature Month Day Year C H ♦ 18.Discrepancy Ise.Discrepancy Indication Space ❑ Quante ❑Type ❑Residue ❑Pamal Rejection ❑Full Rejection Manifest Reference Number. 18b.Aitemate Facility(or Generator) U.S.EPA ID Number J U LL Facililys Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z H19.Hazardous/WWaste RReport Management McOad Codas(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) CILL! 1 ! �76 2 3 4. 20.Designated Facility tor:Certification of receipt of helps atermis covered by the manifest except as orad In Item 1B 1 PrntefTyped Name Signature Mo Da Y r EPA Form 8700-22(Rev.3-05) Previous editions amo DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)