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- �} VJ ?19 d 3q 93-P I � <br /> Please print or type.(Form designed for use on all(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking <br /> 8 17 0 2 J J K <br /> WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 1155 <br /> 5 lato an,pp Mailing Address Generators Site Address(if different than mailing address) <br /> Y,1°&N*Jff Street,Manteca,CA 95337 City of Manteca <br /> 1077 Milo Candini Drive,Manteca,CA 95337 <br /> (209)456-8415 Attn: Greg Showerman <br /> GenerataVs Phone: <br /> 6 T M1er 1 Company Name U.S.EPA ID Number q <br /> QOO /•3a� <br /> 7.Transporter 2 Company Name U. .EPA ID Number <br /> 8. U.S.EPA ID Number <br /> 2500 West Lokern Road,Buttonwillow,CA 93206 <br /> (661) 762-6200 CAD980675276 <br /> Facility's Phone: <br /> ge 9b.U.S.DOT Description(including Proper Shipping Name,Harard Class.ID Number 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group Ip any)) No. Type Quantity WUVal. <br /> 1 <br /> K <br /> NON-RCRA Hazardous Waste, Solids,(Lead) 00 1 D T 18 Y <br /> z z. <br /> W <br /> t'> <br /> 3. <br /> 4. <br /> 14 P IHandmg In Wciions and Adddonal nfonna' n <br /> 9 -1�0% Clean arbors Profile Number: C H 13 12 3 0 7 B <br /> Vegetation 0-5% Wear appropriate Perso l Protective EgUapment as necessary <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to III terms of the attached EPAAcknowledgment of Consent. <br /> I certly that the waste minimtration statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)of(b)(if I am a small quan" nemtor)is true. <br /> GeneratorsfOffenors Printedliyped Name (on behalf of the City ofMaFlfeca) Signs /'� Month Day Year <br /> / Cit A�u 2 l <br /> -.1 16.International Shipments ' <br /> F ❑Impod to U.S. ❑Exporl from U.S. Pod of ktroxit. <br /> = Transporter signature(for exports onty): Date leaving U.S.: <br /> W 17.TmnspoderAcknowledgmenlof Receiptof Materials <br /> W Transporter ntediTyped Na Signature Month Day Year <br /> y ►lam OL <br /> Q Transporter 2 Phntedrryped Name 3 Month Day Year <br /> K <br /> F <br /> I18.Discrepancy18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility for Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Faciliys Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> y19.Hazardous ste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1.17" 7 2, 3. 4. <br /> 20.Designated Facility r:Certification of receipt of harardad materials covered by the manifest except as noted in Ifem 18a <br /> 11I <br /> Pool I yped Name Signature <br /> EPA Form 8700-22(Rev.3-05) Previouseditions amo olete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />